Provider Demographics
NPI:1962202176
Name:WANG, WALT YUCHENG (PHARMD)
Entity type:Individual
Prefix:
First Name:WALT
Middle Name:YUCHENG
Last Name:WANG
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 JAMES ST UNIT 5175
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-8009
Mailing Address - Country:US
Mailing Address - Phone:319-332-2817
Mailing Address - Fax:
Practice Address - Street 1:2821 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4806
Practice Address - Country:US
Practice Address - Phone:319-332-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist