Provider Demographics
NPI:1487824835
Name:FONG, RICHARD LEO (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEO
Last Name:FONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 CABRILLO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3706
Mailing Address - Country:US
Mailing Address - Phone:415-385-7443
Mailing Address - Fax:
Practice Address - Street 1:2033 CABRILLO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3706
Practice Address - Country:US
Practice Address - Phone:415-385-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH60050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist