Provider Demographics
NPI:1275737108
Name:WONG, ANNA PON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:PON
Last Name:WONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 CHIANTI CIR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0667
Mailing Address - Country:US
Mailing Address - Phone:209-521-4735
Mailing Address - Fax:209-521-4735
Practice Address - Street 1:4601 DALE RD.
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-735-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31492183500000X, 1835N1003X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology