Provider Demographics
NPI:1629361035
Name:FANG, BUDDY XOU (PHARMD)
Entity Type:Individual
Prefix:
First Name:BUDDY
Middle Name:XOU
Last Name:FANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8357 NEWFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-4916
Mailing Address - Country:US
Mailing Address - Phone:916-475-9159
Mailing Address - Fax:
Practice Address - Street 1:8357 NEWFIELD CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4916
Practice Address - Country:US
Practice Address - Phone:916-475-9159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist