Healthcare Provider Details

I. General information

NPI: 1730400201
Provider Name (Legal Business Name): CHENG-TSONG CHI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 CHAIN BRIDGE RD
MC LEAN VA
22101-3966
US

IV. Provider business mailing address

1312 CHAIN BRIDGE RD
MC LEAN VA
22101-3966
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-5822
  • Fax: 703-356-8301
Mailing address:
  • Phone: 703-356-5822
  • Fax: 703-356-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202001833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: