Healthcare Provider Details

I. General information

NPI: 1861663015
Provider Name (Legal Business Name): MARIE CHEUNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 COURT ST
BROOKLYN NY
11231-4103
US

IV. Provider business mailing address

1 CVS DR
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 718-222-1193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0515861
License Number StateNY

VIII. Authorized Official

Name: MARIE CHEUNG
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 718-222-1193