Individual
BARRY FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 MAIN ST, WALTHAM, MA 02453-6905
(781) 642-8711
Mailing address
27 ITHACA CIRCLE, NEWTON, MA 02462
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18701
MA
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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