Provider Demographics
NPI:1881613339
Name:WAN, TONY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:WAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S GOLDEN WEST AVE # 103
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7416
Mailing Address - Country:US
Mailing Address - Phone:626-447-9936
Mailing Address - Fax:
Practice Address - Street 1:50 ALESSANDRO PL STE A50
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3162
Practice Address - Country:US
Practice Address - Phone:626-858-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist