Provider Demographics
NPI:1407980790
Name:WONG, JANICE ANH (PHAMD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ANH
Last Name:WONG
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-792-3683
Mailing Address - Fax:
Practice Address - Street 1:FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:17100 EUCLID STREET
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-8010
Practice Address - Country:US
Practice Address - Phone:714-966-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist