Provider Demographics
NPI:1427315076
Name:WONGLI, BERLINDA (PHARMD)
Entity type:Individual
Prefix:
First Name:BERLINDA
Middle Name:
Last Name:WONGLI
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 1:21615 S DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8893
Mailing Address - Country:US
Mailing Address - Phone:240-353-7139
Mailing Address - Fax:
Practice Address - Street 1:13918 CASTLE BLVD
Practice Address - Street 2:APT 204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4954
Practice Address - Country:US
Practice Address - Phone:240-353-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide