Provider Demographics
NPI:1053611681
Name:FUNG, AUDREY S (PHARMD)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:S
Last Name:FUNG
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 1:8540 W DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9155
Mailing Address - Country:US
Mailing Address - Phone:702-240-1784
Mailing Address - Fax:702-240-3842
Practice Address - Street 1:8540 W DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9155
Practice Address - Country:US
Practice Address - Phone:702-240-1784
Practice Address - Fax:702-240-3842
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist