Provider Demographics
NPI:1841765377
Name:HORNG, WAN JEN (RPH)
Entity Type:Individual
Prefix:
First Name:WAN JEN
Middle Name:
Last Name:HORNG
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 1:4052 PIONEER PARKWAY , # 111
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120
Mailing Address - Country:US
Mailing Address - Phone:801-964-3935
Mailing Address - Fax:801-964-3934
Practice Address - Street 1:4052 PIONEER PARKWAY , # 111
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-964-3935
Practice Address - Fax:801-964-3934
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151762-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist