Provider Demographics
NPI:1992252803
Name:FONG, DEREK NORMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:NORMAN
Last Name:FONG
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 1:1062 SMITH WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7338
Mailing Address - Country:US
Mailing Address - Phone:916-208-1737
Mailing Address - Fax:
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA748911835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care