Provider Demographics
NPI:1396055075
Name:WANG, INDRIANI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:INDRIANI
Middle Name:
Last Name:WANG
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 1:112 CROSBY CT
Mailing Address - Street 2:#4
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1829
Mailing Address - Country:US
Mailing Address - Phone:510-567-8101
Mailing Address - Fax:510-567-6850
Practice Address - Street 1:2000 EMBARCADERO
Practice Address - Street 2:SUITE 400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5334
Practice Address - Country:US
Practice Address - Phone:510-567-8101
Practice Address - Fax:510-567-6850
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist