Provider Demographics
NPI:1669722120
Name:FOFUNG, JUDITH (RPH)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FOFUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:TWIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:207 W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2536
Mailing Address - Country:US
Mailing Address - Phone:864-297-3844
Mailing Address - Fax:864-234-9755
Practice Address - Street 1:207 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2536
Practice Address - Country:US
Practice Address - Phone:864-297-3844
Practice Address - Fax:864-234-9755
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist