Active NPI
Jackie Wong
- Pharmacist
- Mahopac, NY
National Provider Identifier
1033751367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 065675
- Practice address
- 159 Route 6
Mahopac, NY 10541-2204 - Phone
- (845) 628-5299
- NPI assigned
- Oct 8, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 065675 | NY | Primary |
Addresses
Primary practice location
159 Route 6
Mahopac, NY 10541-2204
Mailing address
159 Route 6
Mahopac, NY 10541-2204
Phone (845) 628-5299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 065675 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of New York Inc | Past | Accepting new patients | |
| Rite Aid of New York Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Mahopac, NY
- NPI 1336258649
-
- Community/Retail Pharmacy
- New York, NY
- NPI 1639288129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570492800000",
"number": "1033751367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 ROUTE 6",
"city": "MAHOPAC",
"state": "NY",
"postal_code": "105412204",
"telephone_number": "845-628-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 ROUTE 6",
"city": "MAHOPAC",
"state": "NY",
"postal_code": "105412204",
"telephone_number": "845-628-5299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "JACKIE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-08",
"last_updated": "2019-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "065675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mahopac, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.