Healthcare Provider Details

I. General information

NPI: 1104376391
Provider Name (Legal Business Name): SHERI SENE YENE CHONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NE UNIVERSITY VILLAGE ST
SEATTLE WA
98105-5016
US

IV. Provider business mailing address

2700 NE UNIVERSITY VILLAGE ST
SEATTLE WA
98105-5016
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-0705
  • Fax: 206-525-0740
Mailing address:
  • Phone: 206-525-0705
  • Fax: 206-525-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60972736
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: