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General NPI Number Information
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NPI Number | 1619051737
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Entity Type | Organization
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Legal Business Name | FONGS DRUGS
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 621 COMMERCE ST
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City | EARLE
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State | AR
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Zip | 72331-1616
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Country | US
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Telephone | 870-792-8763
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Fax | 870-792-8210
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | MILLINGTON
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State | TN
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Zip | 38083-0513
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Country | US
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Telephone | 870-792-8763
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Fax | 870-792-8210
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Authorized Official
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Title or Position | OWNER
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Name | JESSE FONG
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Credential | PHRM
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Telephone | 870-792-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR02507
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License Number State | AR
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