Provider Demographics
NPI:1669896544
Name:WONG, DUNCAN (RPH, PHARMD)
Entity type:Individual
Prefix:MR
First Name:DUNCAN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 KASLIN DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7907
Mailing Address - Country:US
Mailing Address - Phone:209-613-7018
Mailing Address - Fax:
Practice Address - Street 1:2040 E MARIPOSA RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-7736
Practice Address - Country:US
Practice Address - Phone:209-465-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47059OtherCALIFORNIA BOARD OF PHARMACY