Provider Demographics
NPI:1790381911
Name:FUNG, DAVID L (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:FUNG
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 1:10113 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8254
Mailing Address - Country:US
Mailing Address - Phone:813-244-9882
Mailing Address - Fax:
Practice Address - Street 1:3436 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2830
Practice Address - Country:US
Practice Address - Phone:806-799-3636
Practice Address - Fax:806-795-4622
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist