Provider Demographics
NPI:1417656679
Name:WANG, LUCIA LI (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:LI
Last Name:WANG
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 1:3960 54TH ST APT 7F
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4216
Mailing Address - Country:US
Mailing Address - Phone:718-288-2046
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVE.
Practice Address - Street 2:CLARK/S&R BUILDING, 10TH FL. SUITE 8-1011
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1002
Practice Address - Country:US
Practice Address - Phone:212-523-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist