Provider Demographics
NPI:1821391244
Name:FOFUNG, MUTED (RPH)
Entity Type:Individual
Prefix:
First Name:MUTED
Middle Name:
Last Name:FOFUNG
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 1:4101 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2616
Mailing Address - Country:US
Mailing Address - Phone:301-262-7733
Mailing Address - Fax:301-262-7736
Practice Address - Street 1:4101 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2616
Practice Address - Country:US
Practice Address - Phone:301-262-7733
Practice Address - Fax:301-262-7736
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist