Provider Demographics
NPI:1053953166
Name:FUNG, IRIS KING-CHONG (PHARMD)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:KING-CHONG
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 1:3023 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3544
Mailing Address - Country:US
Mailing Address - Phone:206-792-6342
Mailing Address - Fax:
Practice Address - Street 1:102 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4005
Practice Address - Country:US
Practice Address - Phone:701-265-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23403183500000X
NDRPH6175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist