Provider Demographics
NPI:1225421555
Name:FUNG, PATRICK P (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:P
Last Name:FUNG
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 COCONUT RD
Mailing Address - Street 2:WINN-DIXIE PHARMACY 2525
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8122
Mailing Address - Country:US
Mailing Address - Phone:239-947-2577
Mailing Address - Fax:239-947-7839
Practice Address - Street 1:10026 COCONUT RD
Practice Address - Street 2:WINN-DIXIE PHARMACY 2525
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8122
Practice Address - Country:US
Practice Address - Phone:239-947-2577
Practice Address - Fax:239-947-7839
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist