Provider Demographics
NPI:1558545657
Name:WONG, RAYMOND BOB (RPH,I)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:BOB
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH,I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2439
Mailing Address - Country:US
Mailing Address - Phone:845-267-8386
Mailing Address - Fax:
Practice Address - Street 1:50 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3719
Practice Address - Country:US
Practice Address - Phone:845-638-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist