Provider Demographics
NPI:1336356278
Name:KONG, ELEANOR F (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:F
Last Name:KONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD
Mailing Address - Street 2:STE 446
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-892-0468
Mailing Address - Fax:310-861-1888
Practice Address - Street 1:802 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1408
Practice Address - Country:US
Practice Address - Phone:310-393-9821
Practice Address - Fax:310-917-2669
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH368101835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH36810OtherCA PHARMACIST LICENSE NO.