Healthcare Provider Details

I. General information

NPI: 1023582319
Provider Name (Legal Business Name): STEPHANIE L CHEUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 OXFORD AVE
PHILADELPHIA PA
19111-2224
US

IV. Provider business mailing address

11114 GREINER RD
PHILADELPHIA PA
19116-2602
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-9060
  • Fax:
Mailing address:
  • Phone: 267-575-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452881
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: