=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073834982
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT C CHEN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2010
-----------------------------------------------------
Last Update Date | 06/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 EAST AVE 26 RITE AID
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90031-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-222-8876
-----------------------------------------------------
Fax | 323-223-0144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 EAST AVE 26 RITE AID
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90031-2312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-222-8876
-----------------------------------------------------
Fax | 323-223-0144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH 31722
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------