Provider Demographics
NPI:1326685181
Name:WANG, MARGARET RENA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:RENA
Last Name:WANG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S ST ANDREWS PL APT 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4316
Mailing Address - Country:US
Mailing Address - Phone:518-253-3801
Mailing Address - Fax:
Practice Address - Street 1:4707 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5832
Practice Address - Country:US
Practice Address - Phone:323-938-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-28
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist