Provider Demographics
NPI:1811267776
Name:WONG, DOROTHY SOK MON (RPH)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:SOK MON
Last Name:WONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W BASE LINE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1707
Mailing Address - Country:US
Mailing Address - Phone:909-386-5724
Mailing Address - Fax:909-386-5318
Practice Address - Street 1:1301 W BASE LINE ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1707
Practice Address - Country:US
Practice Address - Phone:909-386-5724
Practice Address - Fax:909-386-5318
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist