Provider Demographics
NPI:1528370715
Name:ONG, MARIETTA TAN (PHARMD,)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:TAN
Last Name:ONG
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 1:2150 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1304
Mailing Address - Country:US
Mailing Address - Phone:650-369-2071
Mailing Address - Fax:650-369-3449
Practice Address - Street 1:2150 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-1304
Practice Address - Country:US
Practice Address - Phone:650-369-2071
Practice Address - Fax:650-369-3449
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist