Provider Demographics
NPI:1508201245
Name:FONGE, ANNE T (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:FONGE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 EAST SHAW ROAD
Mailing Address - Street 2:STRAWBERRY HEALTH CENTER PHARMACY
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506
Mailing Address - Country:US
Mailing Address - Phone:713-982-5168
Mailing Address - Fax:713-982-5185
Practice Address - Street 1:927 EAST SHAW ROAD
Practice Address - Street 2:STRAWBERRY HEALTH CENTER PHARMACY
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506
Practice Address - Country:US
Practice Address - Phone:713-982-5168
Practice Address - Fax:713-982-5185
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist