Provider Demographics
NPI:1881831675
Name:TONG, MOLLY (RPH)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11449 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1022
Mailing Address - Country:US
Mailing Address - Phone:718-848-4900
Mailing Address - Fax:718-848-4903
Practice Address - Street 1:11449 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1022
Practice Address - Country:US
Practice Address - Phone:718-848-4900
Practice Address - Fax:718-848-4903
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923995Medicaid