Healthcare Provider Details

I. General information

NPI: 1417520776
Provider Name (Legal Business Name): JUNNAN CHEN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2989 DERR RD
SPRINGFIELD OH
45503-1369
US

IV. Provider business mailing address

2989 DERR RD
SPRINGFIELD OH
45503-1369
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-0767
  • Fax: 937-390-6344
Mailing address:
  • Phone: 937-390-0767
  • Fax: 937-390-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440776
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03440776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: