Provider Demographics
NPI:1366910325
Name:WAN, QUEENIE HIP YING (PHARMD)
Entity type:Individual
Prefix:DR
First Name:QUEENIE
Middle Name:HIP YING
Last Name:WAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13059 HEDDA LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6145
Mailing Address - Country:US
Mailing Address - Phone:562-565-4672
Mailing Address - Fax:
Practice Address - Street 1:13059 HEDDA LN
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6145
Practice Address - Country:US
Practice Address - Phone:562-565-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792091835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy