Provider Demographics
NPI:1073835922
Name:WONG, ERNIE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ERNIE
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HIGHWAY A1A
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2342
Mailing Address - Country:US
Mailing Address - Phone:321-773-7035
Mailing Address - Fax:
Practice Address - Street 1:1024 HIGHWAY A1A
Practice Address - Street 2:SUITE 120
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2342
Practice Address - Country:US
Practice Address - Phone:321-773-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist