Healthcare Provider Details

I. General information

NPI: 1629235676
Provider Name (Legal Business Name): SUSAN JUI LAN CHEN DMD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 ROBINWOOD RD
GASTONIA NC
28054-1677
US

IV. Provider business mailing address

3691 ROBINWOOD RD
GASTONIA NC
28054-1677
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-7641
  • Fax: 704-866-7730
Mailing address:
  • Phone: 704-865-7641
  • Fax: 704-866-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: