Provider Demographics
NPI:1376828731
Name:FUNG, THOMAS T (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:FUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 LONGFIBRE AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1513
Mailing Address - Country:US
Mailing Address - Phone:509-454-5249
Mailing Address - Fax:509-454-5246
Practice Address - Street 1:2310 LONGFIBRE AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-1513
Practice Address - Country:US
Practice Address - Phone:509-454-5249
Practice Address - Fax:509-454-5246
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist