Healthcare Provider Details

I. General information

NPI: 1508637661
Provider Name (Legal Business Name): MICHELLE CHUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 EASTLAKE AVE E STE 400A
SEATTLE WA
98102-3345
US

IV. Provider business mailing address

9221 INTERLAKE AVE N UNIT 208
SEATTLE WA
98103-3342
US

V. Phone/Fax

Practice location:
  • Phone: 206-838-4590
  • Fax:
Mailing address:
  • Phone: 909-530-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61452683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: