Provider Demographics
NPI:1295119477
Name:WEN, TAO (PHARMD)
Entity type:Individual
Prefix:
First Name:TAO
Middle Name:
Last Name:WEN
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 1:8005 GRAMERCY BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2448
Mailing Address - Country:US
Mailing Address - Phone:580-340-0804
Mailing Address - Fax:
Practice Address - Street 1:8005 GRAMERCY BLVD STE 180
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2448
Practice Address - Country:US
Practice Address - Phone:580-340-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist