Provider Demographics
NPI:1104127406
Name:WONG, WENDY TAKWOON (RPH)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:TAKWOON
Last Name:WONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COOKS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9162
Mailing Address - Country:US
Mailing Address - Phone:360-827-6616
Mailing Address - Fax:360-827-6657
Practice Address - Street 1:1800 COOKS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9162
Practice Address - Country:US
Practice Address - Phone:360-827-6616
Practice Address - Fax:360-827-6657
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042046183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist