Provider Demographics
NPI:1497123541
Name:FONJONG, BIBINA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BIBINA
Middle Name:
Last Name:FONJONG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:BIBINA
Other - Middle Name:
Other - Last Name:TENJOH-OKWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 N HALF HITCH RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1462
Mailing Address - Country:US
Mailing Address - Phone:757-933-0080
Mailing Address - Fax:
Practice Address - Street 1:1151 N HALF HITCH RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1462
Practice Address - Country:US
Practice Address - Phone:757-933-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist