Healthcare Provider Details

I. General information

NPI: 1073834982
Provider Name (Legal Business Name): ROBERT C CHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST AVE 26 RITE AID
LOS ANGELES CA
90031-2312
US

IV. Provider business mailing address

111 EAST AVE 26 RITE AID
LOS ANGELES CA
90031-2312
US

V. Phone/Fax

Practice location:
  • Phone: 323-222-8876
  • Fax: 323-223-0144
Mailing address:
  • Phone: 323-222-8876
  • Fax: 323-223-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 31722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: