Provider Demographics
NPI:1699523654
Name:FANG, ALBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6290 FENNWOOD CT APT H
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-1737
Mailing Address - Country:US
Mailing Address - Phone:408-455-8555
Mailing Address - Fax:
Practice Address - Street 1:9285 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2101
Practice Address - Country:US
Practice Address - Phone:916-714-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist