Healthcare Provider Details

I. General information

NPI: 1962366930
Provider Name (Legal Business Name): JOSEPH LEE CHONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10009 OLD FREDERICK RD
ELLICOTT CITY MD
21042-1646
US

IV. Provider business mailing address

10009 OLD FREDERICK RD
ELLICOTT CITY MD
21042-1646
US

V. Phone/Fax

Practice location:
  • Phone: 301-395-3361
  • Fax:
Mailing address:
  • Phone: 301-395-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: