Provider Demographics
NPI:1417945189
Name:WONG, ADRIAN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WARREN DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1105
Mailing Address - Country:US
Mailing Address - Phone:415-602-0005
Mailing Address - Fax:
Practice Address - Street 1:17 WARREN DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1105
Practice Address - Country:US
Practice Address - Phone:415-602-0005
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist