Provider Demographics
NPI:1487315172
Name:FONG, SELENA YAU (PHARMD)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:YAU
Last Name:FONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:
Other - Last Name:YAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1570 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3303
Mailing Address - Country:US
Mailing Address - Phone:559-437-7370
Mailing Address - Fax:559-437-7322
Practice Address - Street 1:1570 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3303
Practice Address - Country:US
Practice Address - Phone:553-437-7370
Practice Address - Fax:559-437-7322
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist