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General NPI Number Information
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NPI Number | 1669095329
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Entity Type | Individual
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Provider Name | ALVIN FONG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 10800 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505-3043
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Country | US
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Telephone | 951-602-4109
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Fax |
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Provider Business Mailing Address
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Address Line | 1097 SYRACUSE DR
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City | CLAREMONT
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State | CA
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Zip | 91711-2514
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Country | US
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Telephone | 626-215-5896
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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 | 80928
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License Number State | CA
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