Provider Demographics
NPI:1336336742
Name:WANG, GEORGE CHRISTIAN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:CHRISTIAN
Last Name:WANG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 BOULEVARD HEIGHTS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4396
Mailing Address - Country:US
Mailing Address - Phone:360-236-0263
Mailing Address - Fax:
Practice Address - Street 1:5500 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6326
Practice Address - Country:US
Practice Address - Phone:360-456-4057
Practice Address - Fax:360-456-0903
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039038183500000X
TX36379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist