MEDICARE: DR. GRACE I-JU CHEN PHARM.D., CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH51219	CA

General Provider Information

NPI Number	:	1225088016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACE I-JU CHEN PHARM.D., CDE

Provider Business Mailing Address
First Line	:	2278 LYRICAL RD
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 W CHEYENNE AVE
Second Line	:	DEPARTMENT OF PHARMACY
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4325
Country	:	US
Telephone Number	:	702-636-3000
Fax Number	:	702-636-3069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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