Healthcare Provider Details

I. General information

NPI: 1881095214
Provider Name (Legal Business Name): CHENG YEN PU PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

20558 VARSITY DR
WALNUT CA
91789-1221
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: