Provider Demographics
NPI:1922325984
Name:WANG, LILIAN LI-CHUN (LILIAN WANG)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:LI-CHUN
Last Name:WANG
Suffix:
Gender:F
Credentials:LILIAN WANG
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LILIAN WANG
Mailing Address - Street 1:1855 PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2550
Mailing Address - Country:US
Mailing Address - Phone:626-281-2845
Mailing Address - Fax:
Practice Address - Street 1:15331 BASELINE AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5773
Practice Address - Country:US
Practice Address - Phone:909-574-2831
Practice Address - Fax:909-574-1869
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist