Provider Demographics
NPI:1871870758
Name:FUNG, LELA SUSAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LELA
Middle Name:SUSAN
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 1:15110 E SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-9161
Mailing Address - Country:US
Mailing Address - Phone:785-979-8080
Mailing Address - Fax:
Practice Address - Street 1:440 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9508
Practice Address - Country:US
Practice Address - Phone:316-689-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-142391835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy