Provider Demographics
NPI:1295913713
Name:SIU, WAI-CHUEN MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:WAI-CHUEN
Middle Name:MARK
Last Name:SIU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4274 COLLING RD W
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2557
Mailing Address - Country:US
Mailing Address - Phone:619-421-4119
Mailing Address - Fax:
Practice Address - Street 1:3955 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1230
Practice Address - Country:US
Practice Address - Phone:619-409-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH31187OtherRPH LICENSE