Individual
BASIL WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
744 W CAMELBACK RD, PHOENIX, AZ 85013-2207
(602) 279-9337
Mailing address
1126 W STELLA LN, PHOENIX, AZ 85013-1393
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S019271
AZ
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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