Provider Demographics
NPI:1588103543
Name:CHIU-WONG, PEGGY (PHARMD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:CHIU-WONG
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 1:2310 CATALPA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1902
Mailing Address - Country:US
Mailing Address - Phone:650-589-3459
Mailing Address - Fax:
Practice Address - Street 1:2310 CATALPA WAY
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1902
Practice Address - Country:US
Practice Address - Phone:650-589-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist