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NPI Code Detail

MEDICARE: VICKI K FONG RPH

MEDICARE: VICKI K FONG RPH
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
1183500000XPharmacist051.036154IL

General Provider Information

NPI Number : 1679858104
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI K FONG RPH
Provider Business Mailing Address
First Line : 228 W ALEXANDER ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1910
Country : US
Telephone Number : 312-842-1680
Fax Number : 312-842-5228
Provider Business Practice Location Address
First Line : 316 W CERMAK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60616-1916
Country : US
Telephone Number : 312-791-0392
Fax Number : 312-791-0461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2011
Last Update Date : 10/16/2011

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