Provider Demographics
NPI:1114530433
Name:FU, QUANHAO
Entity Type:Individual
Prefix:DR
First Name:QUANHAO
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08029-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:NJ
Practice Address - Zip Code:08029-1307
Practice Address - Country:US
Practice Address - Phone:856-939-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03919200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist