Healthcare Provider Details

I. General information

NPI: 1720292188
Provider Name (Legal Business Name): PETER PE CHU PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 EL TORO RD
LAGUNA WOODS CA
92637-2775
US

IV. Provider business mailing address

25 POLLENA
IRVINE CA
92602-1648
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-0391
  • Fax: 949-830-1141
Mailing address:
  • Phone: 714-665-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH48836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: