Provider Demographics
NPI:1841362480
Name:WONG, LESTER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 YUCCA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9378
Mailing Address - Country:US
Mailing Address - Phone:805-491-3689
Mailing Address - Fax:805-482-6324
Practice Address - Street 1:900 AVENIDA ACASO
Practice Address - Street 2:SUITE A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8749
Practice Address - Country:US
Practice Address - Phone:805-388-9336
Practice Address - Fax:805-482-6324
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH043209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist