Provider Demographics
NPI:1437445517
Name:WANG, JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 E POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4035
Mailing Address - Country:US
Mailing Address - Phone:651-458-8219
Mailing Address - Fax:651-458-8219
Practice Address - Street 1:8655 E POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4035
Practice Address - Country:US
Practice Address - Phone:651-458-8219
Practice Address - Fax:651-458-8219
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist