Healthcare Provider Details

I. General information

NPI: 1457870826
Provider Name (Legal Business Name): SHERRI ELIZABETH GONG-CHUN RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HERNDON AVE
CLOVIS CA
93611-0505
US

IV. Provider business mailing address

2495 FAIRMONT AVE
CLOVIS CA
93611-6530
US

V. Phone/Fax

Practice location:
  • Phone: 559-597-6410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: