Provider Demographics
NPI:1619418142
Name:WANG, AUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WANG
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 1:1598 WHARTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2075
Mailing Address - Country:US
Mailing Address - Phone:408-772-0506
Mailing Address - Fax:
Practice Address - Street 1:2350 MCKEE RD STE A3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1617
Practice Address - Country:US
Practice Address - Phone:408-923-8871
Practice Address - Fax:408-259-4416
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60676756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist