Provider Demographics
NPI:1548581531
Name:WONG, PAULA (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
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 1:2521 87TH AVE W APT 240
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1824
Mailing Address - Country:US
Mailing Address - Phone:718-683-2056
Mailing Address - Fax:
Practice Address - Street 1:7041 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7220
Practice Address - Country:US
Practice Address - Phone:253-474-0115
Practice Address - Fax:253-474-0253
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60096475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist