Healthcare Provider Details

I. General information

NPI: 1316351414
Provider Name (Legal Business Name): JUDY CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704-20 EAST PASSYUNK AVE
PHILADELPHIA PA
19147
US

IV. Provider business mailing address

704-20 EAST PASSYUNK AVE
PHILA PA
19147
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-3151
  • Fax: 215-627-1364
Mailing address:
  • Phone: 215-301-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444967
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: