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General NPI Number Information
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NPI Number | 1164718342
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Entity Type | Individual
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Provider Name | MR. WING K FUNG
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Gender | Male
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Dates
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Enumeration Date | 06/25/2011
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Last Update Date | 06/25/2011
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Provider Practice Location Address
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Address Line | 335 CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-3922
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Country | US
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Telephone | 860-649-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 MILL POND DR
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3560
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Country | US
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Telephone | 860-644-6824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5629
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License Number State | CT
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