Provider Demographics
NPI:1710777545
Name:FONG, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:FONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SHETTER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3455
Mailing Address - Country:US
Mailing Address - Phone:904-710-3483
Mailing Address - Fax:904-710-3483
Practice Address - Street 1:1300 SHETTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3455
Practice Address - Country:US
Practice Address - Phone:904-710-3483
Practice Address - Fax:904-710-3483
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045038333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy