Provider Demographics
NPI:1174796908
Name:WONG, SELENA (RPH)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-3458
Mailing Address - Country:US
Mailing Address - Phone:781-837-5163
Mailing Address - Fax:781-837-0195
Practice Address - Street 1:1 SNOW RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-3458
Practice Address - Country:US
Practice Address - Phone:781-837-5163
Practice Address - Fax:781-837-0195
Is Sole Proprietor?:No
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26599183500000X
NHR1488183500000X
NC12304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist