Provider Demographics
NPI:1629339684
Name:GUO, WEI
Entity Type:Individual
Prefix:
First Name:WEI
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 VAN SICKLEN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2738
Mailing Address - Country:US
Mailing Address - Phone:609-716-6750
Mailing Address - Fax:
Practice Address - Street 1:10 SCHALKS CROSSING RD
Practice Address - Street 2:SUPERFRESH PHARMACY
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1612
Practice Address - Country:US
Practice Address - Phone:609-378-0223
Practice Address - Fax:609-716-8996
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02703700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02703700OtherSTATE LICENSE