Healthcare Provider Details

I. General information

NPI: 1538653530
Provider Name (Legal Business Name): SANDY MENG-SHAN CHUNG PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S FETTERLY AVE
EAST LOS ANGELES CA
90022-1605
US

IV. Provider business mailing address

2235 SHERWOOD RD
SAN MARINO CA
91108-2837
US

V. Phone/Fax

Practice location:
  • Phone: 805-814-0913
  • Fax:
Mailing address:
  • Phone: 805-814-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number77603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: