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NPI Code Detail

MEDICARE: MRS. LIZ FONG PHARM D

MEDICARE: MRS. LIZ FONG PHARM D
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
1183500000XPharmacist042910CA

General Provider Information

NPI Number : 1134400179
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LIZ FONG PHARM D
Provider Business Mailing Address
First Line : 205 AVINGTON RD
Second Line :
City : ALAMEDA
State : CA
Zip : 94502-6433
Country : US
Telephone Number : 510-523-3664
Fax Number : 510-523-7021
Provider Business Practice Location Address
First Line : 2300 OTIS DR
Second Line :
City : ALAMEDA
State : CA
Zip : 94501-5722
Country : US
Telephone Number : 510-523-7043
Fax Number : 510-523-7021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2011
Last Update Date : 09/05/2011

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