Provider Demographics
NPI:1649565839
Name:WANG, JOANNIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOANNIE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 ROUTE 34
Mailing Address - Street 2:T1402
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8333
Mailing Address - Country:US
Mailing Address - Phone:630-554-4005
Mailing Address - Fax:
Practice Address - Street 1:3020 ROUTE 34
Practice Address - Street 2:T1402
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8333
Practice Address - Country:US
Practice Address - Phone:630-554-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist