Provider Demographics
NPI:1912228313
Name:ONG, JEANNETTE KAYE (PHARM D)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:KAYE
Last Name:ONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 CASTRO VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4502
Mailing Address - Country:US
Mailing Address - Phone:510-886-3341
Mailing Address - Fax:510-886-4896
Practice Address - Street 1:3848 CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4502
Practice Address - Country:US
Practice Address - Phone:510-886-3341
Practice Address - Fax:510-886-4896
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist