Provider Demographics
NPI:1225447360
Name:FONJUNGO, GEORGE E (MPHARM, PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:FONJUNGO
Suffix:
Gender:M
Credentials:MPHARM, PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 AXTON CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2050
Mailing Address - Country:US
Mailing Address - Phone:240-274-4613
Mailing Address - Fax:
Practice Address - Street 1:702 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-2400
Practice Address - Country:US
Practice Address - Phone:410-671-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-02
Last Update Date:2014-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11344183500000X
VA0202010285183500000X
TX27894183500000X
NY037720-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist