=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124350160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE CHEUNG RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2010
-----------------------------------------------------
Last Update Date | 02/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25707 UNION TPKE
-----------------------------------------------------
City | GLEN OAKS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11004-1250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-343-0070
-----------------------------------------------------
Fax | 718-343-0096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7308 188TH ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11366-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-454-0978
-----------------------------------------------------
Fax | 718-343-0096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 040463
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------