Basic Information
| Provider Information | |||||||||
| NPI: | 1982844775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | FREDDIE | ||||||||
| MiddleName: | YIU-FUNG | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 KNIGHT LANE | ||||||||
| Address2: | NAVY MEDICINE SUPPORT COMMAND BUILDING H | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326460 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 34800 BOB WILSON DR | ||||||||
| Address2: | PHARMACY DEPT | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921341098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 117349 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.