Provider Demographics
NPI:1932483880
Name:WANG, STEPHEN Y
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13255 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3127
Mailing Address - Country:US
Mailing Address - Phone:904-220-6606
Mailing Address - Fax:904-220-0633
Practice Address - Street 1:13255 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3127
Practice Address - Country:US
Practice Address - Phone:904-220-6606
Practice Address - Fax:904-220-0633
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0024206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist