Basic Information
| Provider Information | |||||||||
| NPI: | 1205334083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2916 DATE ST APT 6C | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968161185 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 PALI HWY | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085365542 | ||||||||
| FaxNumber: | 8085360659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH-2136 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.