Provider Demographics
NPI:1740614916
Name:FONG, JEANNIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25108 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4430
Mailing Address - Country:US
Mailing Address - Phone:281-644-6412
Mailing Address - Fax:281-644-6415
Practice Address - Street 1:25108 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4430
Practice Address - Country:US
Practice Address - Phone:281-644-6412
Practice Address - Fax:281-644-6415
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist