Provider Demographics
NPI:1447527072
Name:WONG, SANDRA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:WONG
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 1:3380 COACH LN
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8454
Mailing Address - Country:US
Mailing Address - Phone:530-676-6938
Mailing Address - Fax:530-676-6942
Practice Address - Street 1:3380 COACH LN
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8454
Practice Address - Country:US
Practice Address - Phone:530-676-6938
Practice Address - Fax:530-676-6942
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist