Provider Demographics
NPI:1548873243
Name:WONG, CARLOS HUMBERTO (PHARMD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:HUMBERTO
Last Name:WONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13330 SW 17TH LN APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7611
Mailing Address - Country:US
Mailing Address - Phone:786-306-9273
Mailing Address - Fax:
Practice Address - Street 1:9510 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3300
Practice Address - Country:US
Practice Address - Phone:305-971-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist