Healthcare Provider Details

I. General information

NPI: 1982985651
Provider Name (Legal Business Name): SEAN F CHUNG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N GREENWOOD AVE
NILES IL
60714-1408
US

IV. Provider business mailing address

743 HANBURY DR
DES PLAINES IL
60016-1567
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-3050
  • Fax:
Mailing address:
  • Phone: 847-772-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051291448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: