MEDICARE: MR. PATRICK P FUNG BSPHARM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS15640	FL

General Provider Information

NPI Number	:	1225421555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK P FUNG BSPHARM

Provider Business Mailing Address
First Line	:	10026 COCONUT RD
Second Line	:	WINN-DIXIE PHARMACY 2525
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-8122
Country	:	US
Telephone Number	:	239-947-2577
Fax Number	:	239-947-7839

Provider Business Practice Location Address
First Line	:	10026 COCONUT RD
Second Line	:	WINN-DIXIE PHARMACY 2525
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-8122
Country	:	US
Telephone Number	:	239-947-2577
Fax Number	:	239-947-7839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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