Provider Demographics
NPI:1659692705
Name:WANG, FANG-JIUN JENNIFER (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:FANG-JIUN
Middle Name:JENNIFER
Last Name:WANG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5490 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4113
Mailing Address - Country:US
Mailing Address - Phone:323-721-9718
Mailing Address - Fax:323-721-7210
Practice Address - Street 1:5490 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-4113
Practice Address - Country:US
Practice Address - Phone:323-721-9718
Practice Address - Fax:323-721-7210
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist