Provider Demographics
NPI:1558632950
Name:CHEUNG, FONG JOLLY (RPH)
Entity Type:Individual
Prefix:
First Name:FONG
Middle Name:JOLLY
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3131
Mailing Address - Country:US
Mailing Address - Phone:201-384-5096
Mailing Address - Fax:201-384-6690
Practice Address - Street 1:31 SCOTT DR
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3131
Practice Address - Country:US
Practice Address - Phone:201-384-5096
Practice Address - Fax:201-384-6690
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02289500183500000X
NY055579183500000X
FLPS46924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist