Healthcare Provider Details

I. General information

NPI: 1932424512
Provider Name (Legal Business Name): FAN FONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13502 ROOSEVELT AVE
FLUSHING NY
11354-5313
US

IV. Provider business mailing address

13502 ROOSEVELT AVE
FLUSHING NY
11354-5313
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: