Provider Demographics
NPI:1902402001
Name:WONG, LARAH KHAW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LARAH
Middle Name:KHAW
Last Name:WONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LARAH
Other - Middle Name:
Other - Last Name:KHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WHITE HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:384 GANNETT RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1220
Practice Address - Country:US
Practice Address - Phone:781-545-1020
Practice Address - Fax:781-545-8582
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH263111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist