=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053414201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHUNG WAH PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 MOTT STREET
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-587-4160
-----------------------------------------------------
Fax | 212-587-4167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65 MOTT STREET
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-587-4160
-----------------------------------------------------
Fax | 212-587-4167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PHARMACIST
-----------------------------------------------------
Name | HARRY G LEW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-587-4160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 021395
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------