Provider Demographics
NPI:1235434515
Name:FOWUNG, PRISCA ACHEA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:PRISCA
Middle Name:ACHEA
Last Name:FOWUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GRAND CONCOURSE
Mailing Address - Street 2:APPT 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2759
Mailing Address - Country:US
Mailing Address - Phone:718-664-3264
Mailing Address - Fax:
Practice Address - Street 1:58 EAST FORDAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-365-9354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054379-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist