Provider Demographics
NPI:1124433081
Name:AKRONG, ABIGAIL (PHARMD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:AKRONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12583 MONTELLANO LN
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-7320
Mailing Address - Country:US
Mailing Address - Phone:909-450-6371
Mailing Address - Fax:
Practice Address - Street 1:12583 MONTELLANO LN
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-7320
Practice Address - Country:US
Practice Address - Phone:909-450-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist