Provider Demographics
NPI:1790764330
Name:WONG, DELORES (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5022
Mailing Address - Country:US
Mailing Address - Phone:908-604-9545
Mailing Address - Fax:908-604-0580
Practice Address - Street 1:62 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5607
Practice Address - Country:US
Practice Address - Phone:908-754-4400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01897900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist