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NPI Code Detail

MEDICARE: DR. KY NOUKY FANG PHARM. D.

MEDICARE: DR. KY NOUKY FANG 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
1183500000XPharmacist118487MN

General Provider Information

NPI Number : 1356623490
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KY NOUKY FANG PHARM. D.
Provider Business Mailing Address
First Line : 7135 E POINT DOUGLAS RD S
Second Line :
City : COTTAGE GROVE
State : MN
Zip : 55016-3014
Country : US
Telephone Number : 651-459-7015
Fax Number : 651-459-1922
Provider Business Practice Location Address
First Line : 7135 E POINT DOUGLAS RD S
Second Line :
City : COTTAGE GROVE
State : MN
Zip : 55016-3014
Country : US
Telephone Number : 651-459-7015
Fax Number : 651-459-1922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2011
Last Update Date : 09/14/2011

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