Provider Demographics
NPI:1154572303
Name:WONG, PHILIP (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85-04 63 DRIVE
Mailing Address - Street 2:APT. 3 J
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4816
Mailing Address - Country:US
Mailing Address - Phone:718-897-0036
Mailing Address - Fax:
Practice Address - Street 1:79-25 WINCHESTER BLVD.
Practice Address - Street 2:CREEDMOOR PSYCHIATRIC CENTER PHARMACY DEPARTMENT
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427
Practice Address - Country:US
Practice Address - Phone:718-264-4022
Practice Address - Fax:718-264-4293
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist