Provider Demographics
NPI:1922385509
Name:WONG, PATTIE G (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:PATTIE
Middle Name:G
Last Name:WONG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-6907
Mailing Address - Country:US
Mailing Address - Phone:901-382-1616
Mailing Address - Fax:901-385-2857
Practice Address - Street 1:3360 N WATKINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6432
Practice Address - Country:US
Practice Address - Phone:901-353-4640
Practice Address - Fax:901-353-6865
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5042183500000X
TNC-5042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist