Provider Demographics
NPI:1447551775
Name:WONG, BARNETT (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:BARNETT
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 WOODCREEK OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5152
Mailing Address - Country:US
Mailing Address - Phone:916-780-9929
Mailing Address - Fax:916-780-9887
Practice Address - Street 1:9045 WOODCREEK OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5152
Practice Address - Country:US
Practice Address - Phone:916-780-9929
Practice Address - Fax:916-780-9887
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist