Provider Demographics
NPI:1265807853
Name:WONG, HENRY (PHARMD)
Entity type:Individual
Prefix:
First Name:HENRY
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 1:104 BAY 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4807
Mailing Address - Country:US
Mailing Address - Phone:646-217-2401
Mailing Address - Fax:
Practice Address - Street 1:104 BAY 25TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:646-217-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060884OtherNYS EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS