Provider Demographics
NPI:1124130497
Name:FONG, JAMES JE
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JE
Last Name:FONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-240 HOKULOA LOOP
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55-510 KAMEHAMEHA HWY
Practice Address - Street 2:D.A. PHARMACY
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762
Practice Address - Country:US
Practice Address - Phone:808-293-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist