Provider Demographics
NPI:1790027035
Name:ARIAS, JESSIE WONG (RPH)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:WONG
Last Name:ARIAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W PARKRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-1450
Mailing Address - Country:US
Mailing Address - Phone:951-278-1852
Mailing Address - Fax:
Practice Address - Street 1:120 W PARKRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1450
Practice Address - Country:US
Practice Address - Phone:951-278-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist