Provider Demographics
NPI:1477740421
Name:WONG, LOURDES CRISTINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:CRISTINA
Last Name:WONG
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 1:8110 THAMES BLVD
Mailing Address - Street 2:APT. B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8528
Mailing Address - Country:US
Mailing Address - Phone:561-451-1092
Mailing Address - Fax:
Practice Address - Street 1:6390 N. STATE RD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-570-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist