Provider Demographics
NPI:1053643510
Name:WANG, KATIE M (PHARMD)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:M
Last Name:WANG
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 1:3110 23RD ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4585
Mailing Address - Country:US
Mailing Address - Phone:412-417-2856
Mailing Address - Fax:
Practice Address - Street 1:1294 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1104
Practice Address - Country:US
Practice Address - Phone:212-996-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052463-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist