Provider Demographics
NPI:1013236199
Name:WONG, KWOK KWONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KWOK
Middle Name:KWONG
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:K
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:817 NW EDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1310
Mailing Address - Country:US
Mailing Address - Phone:541-926-2600
Mailing Address - Fax:
Practice Address - Street 1:1235 WAVERLY DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6944
Practice Address - Country:US
Practice Address - Phone:541-926-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist