Provider Demographics
NPI:1003190653
Name:FANG, ALAN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1300
Mailing Address - Country:US
Mailing Address - Phone:617-770-3435
Mailing Address - Fax:617-770-9263
Practice Address - Street 1:550 ADAMS ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1300
Practice Address - Country:US
Practice Address - Phone:617-770-3435
Practice Address - Fax:617-770-9263
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist