Provider Demographics
NPI:1699895284
Name:KONG, RAYMOND L (PHARM D)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:KONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 E CASTRO VALLEY BLVD
Mailing Address - Street 2:#407
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-4840
Mailing Address - Country:US
Mailing Address - Phone:510-885-8954
Mailing Address - Fax:510-885-8954
Practice Address - Street 1:4061 E CASTRO VALLEY BLVD
Practice Address - Street 2:#407
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-4840
Practice Address - Country:US
Practice Address - Phone:510-885-8954
Practice Address - Fax:510-885-8954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist