Provider Demographics
NPI:1598065526
Name:HE, WENLONG (RPH)
Entity Type:Individual
Prefix:
First Name:WENLONG
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4441
Mailing Address - Country:US
Mailing Address - Phone:541-750-0166
Mailing Address - Fax:541-750-0168
Practice Address - Street 1:450 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4441
Practice Address - Country:US
Practice Address - Phone:541-750-0166
Practice Address - Fax:541-750-0168
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9957183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist