Provider Demographics
NPI:1477005437
Name:WANG, AMY Y (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:Y
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 1:13426 SE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6815
Mailing Address - Country:US
Mailing Address - Phone:646-642-5547
Mailing Address - Fax:
Practice Address - Street 1:104 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6927
Practice Address - Country:US
Practice Address - Phone:253-538-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60666585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist