Provider Demographics
NPI:1871990242
Name:CHEN WONG, TECK (PHARMD)
Entity type:Individual
Prefix:
First Name:TECK
Middle Name:
Last Name:CHEN 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 1:400 COLONY BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-6086
Mailing Address - Country:US
Mailing Address - Phone:352-205-7010
Mailing Address - Fax:
Practice Address - Street 1:400 COLONY BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-6086
Practice Address - Country:US
Practice Address - Phone:352-205-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24996183500000X
PR6279183500000X
FLPS60468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS60468OtherBOP FL