Provider Demographics
NPI:1093016644
Name:FANG, FANG (RPH/PHD)
Entity Type:Individual
Prefix:DR
First Name:FANG
Middle Name:
Last Name:FANG
Suffix:
Gender:F
Credentials:RPH/PHD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5721
Mailing Address - Country:US
Mailing Address - Phone:253-852-5115
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5721
Practice Address - Country:US
Practice Address - Phone:253-852-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60133101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist