Provider Demographics
NPI:1700333838
Name:FONG, ASHLEY GILLIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GILLIAN
Last Name:FONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MADISON AVE
Mailing Address - Street 2:APT. 8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5412
Mailing Address - Country:US
Mailing Address - Phone:310-490-4588
Mailing Address - Fax:
Practice Address - Street 1:155 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4766
Practice Address - Country:US
Practice Address - Phone:212-683-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist