Provider Demographics
NPI:1063884633
Name:IP, WING SZE TINA
Entity type:Individual
Prefix:DR
First Name:WING SZE
Middle Name:TINA
Last Name:IP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WING SZE
Other - Middle Name:TINA
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:740 W ALLUVIAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5509
Mailing Address - Country:US
Mailing Address - Phone:800-797-3543
Mailing Address - Fax:
Practice Address - Street 1:4211 SOUTH AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:323-233-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 71751183500000X, 1835P1300X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care