Provider Demographics
NPI:1528043189
Name:WONG-FLORES, JESSICA NGA-YAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NGA-YAN
Last Name:WONG-FLORES
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 1:10305 STEAMBOAT LANDING LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2543
Mailing Address - Country:US
Mailing Address - Phone:360-286-4227
Mailing Address - Fax:
Practice Address - Street 1:10305 STEAMBOAT LANDING LN
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2543
Practice Address - Country:US
Practice Address - Phone:360-286-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047649-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist