Provider Demographics
NPI:1962959171
Name:WONG, TOMMY GIALUN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:GIALUN
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NW LOST SPRINGS TER
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6473
Mailing Address - Country:US
Mailing Address - Phone:415-568-5613
Mailing Address - Fax:
Practice Address - Street 1:364 SE 8TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-681-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist