Provider Demographics
NPI:1598052755
Name:WONG, KELDON KYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELDON
Middle Name:KYLE
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19105 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1428
Mailing Address - Country:US
Mailing Address - Phone:661-977-5155
Mailing Address - Fax:661-977-5165
Practice Address - Street 1:19105 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-1428
Practice Address - Country:US
Practice Address - Phone:661-977-5155
Practice Address - Fax:661-977-5165
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45610183500000X
CA62362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist