Provider Demographics
NPI:1255492435
Name:FONG, ELIZABETH E (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
Last Name:FONG
Suffix:
Gender:F
Credentials:PHARM D
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Other - Credentials:
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:CHEMO PHARMACY MOB #3 BASEMENT
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-4947
Mailing Address - Fax:909-427-5452
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:CHEMO PHARMACY MOB #3 BASEMENT
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-4947
Practice Address - Fax:909-427-5452
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA33139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist