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General NPI Number Information
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NPI Number | 1447819040
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Entity Type | Individual
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Provider Name | JOHN CHEN
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Gender | Male
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 7117 INWOOD RD
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City | DALLAS
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State | TX
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Zip | 75209-4803
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Country | US
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Telephone | 214-350-3583
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Fax |
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Provider Business Mailing Address
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Address Line | 2259 COLCA CANYON RD
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-4143
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Country | US
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Telephone | 817-247-1469
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 57071
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License Number State | TX
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