Provider Demographics
NPI:1518491661
Name:TONG, ANDY (PHARMD, BCGP)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:TONG
Suffix:
Gender:M
Credentials:PHARMD, BCGP
Other - Prefix:DR
Other - First Name:PHANAN
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BCGP
Mailing Address - Street 1:50 HILLCREST MEDICAL BLVD STE 200-1
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8952
Mailing Address - Country:US
Mailing Address - Phone:512-965-5490
Mailing Address - Fax:254-202-3789
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 200-1
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8952
Practice Address - Country:US
Practice Address - Phone:254-202-3760
Practice Address - Fax:254-202-3789
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX511591835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric