Healthcare Provider Details

I. General information

NPI: 1922415033
Provider Name (Legal Business Name): ANDREW CHEUNG PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 ELK GROVE BLVD
ELK GROVE CA
95758-9573
US

IV. Provider business mailing address

8455 ELK GROVE BLVD
ELK GROVE CA
95758-9573
US

V. Phone/Fax

Practice location:
  • Phone: 916-509-3212
  • Fax: 916-509-3184
Mailing address:
  • Phone: 916-509-3212
  • Fax: 916-509-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: