Provider Demographics
NPI:1356742878
Name:WONG, AILEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:YANAN
Other - Last Name:SHIUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6601 TENNYSON ST NE
Mailing Address - Street 2:APT 12104
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8161
Mailing Address - Country:US
Mailing Address - Phone:505-917-7005
Mailing Address - Fax:
Practice Address - Street 1:8011 VENTURA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6429
Practice Address - Country:US
Practice Address - Phone:505-217-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist