Provider Demographics
NPI:1760086938
Name:WONG, ROSALINA M (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROSALINA
Middle Name:M
Last Name:WONG
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 1:6690 EAGLE NEST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2264
Mailing Address - Country:US
Mailing Address - Phone:305-821-1402
Mailing Address - Fax:305-828-3142
Practice Address - Street 1:6690 EAGLE NEST LN
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2264
Practice Address - Country:US
Practice Address - Phone:305-821-1402
Practice Address - Fax:305-828-3142
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist