Individual
BRANDON TYLER FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7901 WATT AVE, ANTELOPE, CA 95843-2002
(916) 747-2746
Mailing address
9204 MANASQUAN CT, ELK GROVE, CA 95758-7485
(916) 747-2746
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
79452
CA
Other
Enumeration date
01/11/2019
Last updated
01/11/2019
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