Individual
IVAN WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
17615 140TH AVE SE, RENTON, WA 98058
(425) 204-1585
(425) 204-0743
Mailing address
17615 140TH AVE SE, RENTON, WA 98058-6828
(425) 204-1585
(425) 204-0743
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00063119
WA
Other
Enumeration date
09/10/2010
Last updated
09/16/2010
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