Healthcare Provider Details

I. General information

NPI: 1457621542
Provider Name (Legal Business Name): NANCY CHUNG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 HAHLO ST
HOUSTON TX
77020-3022
US

IV. Provider business mailing address

1441 MOURSUND ST
HOUSTON TX
77030-3407
US

V. Phone/Fax

Practice location:
  • Phone: 713-674-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: