Provider Demographics
NPI:1649352154
Name:TONG, MARY (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 BROADWAY ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2226
Mailing Address - Country:US
Mailing Address - Phone:707-645-2523
Mailing Address - Fax:707-645-2530
Practice Address - Street 1:1761 BROADWAY ST
Practice Address - Street 2:SUITE 209
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2226
Practice Address - Country:US
Practice Address - Phone:707-645-2523
Practice Address - Fax:707-645-2530
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist