Healthcare Provider Details

I. General information

NPI: 1740226489
Provider Name (Legal Business Name): INSOON CHUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CHUNG PHARMD

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

1327 70TH ST
BROOKLYN NY
11228-1607
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax:
Mailing address:
  • Phone: 718-232-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS28175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: