Provider Demographics
NPI:1790004505
Name:WONG, DONALD (RPH CIP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E PROVIDENCE CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4029
Mailing Address - Country:US
Mailing Address - Phone:609-652-2141
Mailing Address - Fax:
Practice Address - Street 1:425 NEW RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2143
Practice Address - Country:US
Practice Address - Phone:609-653-6611
Practice Address - Fax:609-653-0062
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01573000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist