Provider Demographics
NPI:1639876139
Name:FUNG, BRIAN (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FUNG
Suffix:
Gender:M
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 1ST ST SW APT 839
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3761
Mailing Address - Country:US
Mailing Address - Phone:202-750-5692
Mailing Address - Fax:
Practice Address - Street 1:2121 1ST ST SW APT 839
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3761
Practice Address - Country:US
Practice Address - Phone:202-750-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122628183500000X
UT9027449-1701183500000X
FLPS50431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122628OtherMINNESOTA BOARD OF PHARMACY
FLPS50431OtherFLORIDA BOARD OF PHARMACY
UT9027449-1701OtherUTAH DIVISION OF PROFESSIONAL LICENSING