Provider Demographics
NPI:1609338524
Name:XIONG, FONG TOYED
Entity Type:Individual
Prefix:
First Name:FONG
Middle Name:TOYED
Last Name:XIONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BRIDGE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3028
Mailing Address - Country:US
Mailing Address - Phone:209-556-7950
Mailing Address - Fax:
Practice Address - Street 1:2007 N BELFAST AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4363
Practice Address - Country:US
Practice Address - Phone:207-622-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR68961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist