Active NPI
Wan So
- Pharmacist
- Mount Ephraim, NJ
National Provider Identifier
1548858004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03481900
- Practice address
- 24 S Black Horse Pike
Mount Ephraim, NJ 08059-1321 - Phone
- (215) 606-8291
- NPI assigned
- Jan 8, 2021
- Last updated
- Jan 8, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP451430 | PA | |
| Pharmacist | 183500000X | 28RI03481900 | NJ | Primary |
Addresses
Primary practice location
24 S Black Horse Pike
Mount Ephraim, NJ 08059-1321
Mailing address
1214 N 4TH St
Philadelphia, PA 19122-4404
Phone (215) 606-8291
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 |
|---|---|---|---|
| 28RI03481900 | NJ | MD | Pharmacist |
| RP451430 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610064000000",
"number": "1548858004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1214 N 4TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191224404",
"telephone_number": "215-606-8291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 S BLACK HORSE PIKE",
"city": "MOUNT EPHRAIM",
"state": "NJ",
"postal_code": "080591321",
"telephone_number": "215-606-8291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SO",
"first_name": "WAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-08",
"last_updated": "2021-01-08",
"certification_date": "2021-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP451430",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03481900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Ephraim, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.