Provider Demographics
NPI:1356536320
Name:VONG, WAI H (BS PHARM)
Entity type:Individual
Prefix:MR
First Name:WAI
Middle Name:H
Last Name:VONG
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:VONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1001 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6232
Mailing Address - Country:US
Mailing Address - Phone:702-877-2162
Mailing Address - Fax:702-877-1442
Practice Address - Street 1:1001 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6232
Practice Address - Country:US
Practice Address - Phone:702-877-2162
Practice Address - Fax:702-877-1442
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13730183500000X
CA50545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist