Provider Demographics
NPI:1790256907
Name:WONG, GARLAN PHILIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:GARLAN
Middle Name:PHILIP
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 WORKMAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2360
Mailing Address - Country:US
Mailing Address - Phone:323-334-7823
Mailing Address - Fax:
Practice Address - Street 1:8900 SEPULVEDA WESTWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3619
Practice Address - Country:US
Practice Address - Phone:310-258-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist