Provider Demographics
NPI:1699390609
Name:WONG, VINCENT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:WONG
Suffix:
Gender:M
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 1:13501 HYMEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1763
Mailing Address - Country:US
Mailing Address - Phone:724-436-1318
Mailing Address - Fax:
Practice Address - Street 1:13501 HYMEADOW CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1763
Practice Address - Country:US
Practice Address - Phone:724-436-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553041835P1200X
TX408661835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy