Provider Demographics
NPI:1437434479
Name:WANG, JONATHAN F (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:WANG
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 1:3627 SALEM WALK
Mailing Address - Street 2:APT# B2
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8514
Mailing Address - Country:US
Mailing Address - Phone:847-208-9367
Mailing Address - Fax:
Practice Address - Street 1:780 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4305
Practice Address - Country:US
Practice Address - Phone:847-945-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist