MEDICARE: KAN W KONG RPH

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
1	183500000X	Pharmacist	0202007240	VA

General Provider Information

NPI Number	:	1730526948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAN W KONG RPH

Provider Business Mailing Address
First Line	:	1032 CONJURERS DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2172
Country	:	US
Telephone Number	:	804-458-1231
Fax Number	:	804-458-6742

Provider Business Practice Location Address
First Line	:	2305 OAKLAWN BLVD
Second Line	:
City	:	HOPEWELL
State	:	VA
Zip	:	23860-5032
Country	:	US
Telephone Number	:	804-458-1231
Fax Number	:	804-458-6742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	05/29/2013

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