Provider Demographics
NPI:1396045589
Name:FONG, CYNTHIA LYNN (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:FONG
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8529
Mailing Address - Country:US
Mailing Address - Phone:901-756-7408
Mailing Address - Fax:901-758-3650
Practice Address - Street 1:4770 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8529
Practice Address - Country:US
Practice Address - Phone:901-756-7408
Practice Address - Fax:901-758-3650
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000101561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist