Provider Demographics
NPI:1740357003
Name:WONG, ALLEN W (RPH)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:W
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITE HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3549
Mailing Address - Country:US
Mailing Address - Phone:781-536-8183
Mailing Address - Fax:
Practice Address - Street 1:2253 STATE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5150
Practice Address - Country:US
Practice Address - Phone:508-833-3875
Practice Address - Fax:508-833-6581
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25932183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy