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General NPI Number Information
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NPI Number | 1700878675
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Entity Type | Organization
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Legal Business Name | WILLIAM CHUNG
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 1902 ROYALTY DR STE110
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City | POMONA
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State | CA
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Zip | 91767-3030
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Country | US
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Telephone | 909-620-0343
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Fax | 909-629-1748
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Provider Business Mailing Address
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Address Line | 1932 ERVILLA PL
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City | POMONA
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State | CA
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Zip | 91767-3019
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Country | US
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Telephone | 909-629-2823
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Fax | 909-629-2891
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | MARLA FREED
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Credential |
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Telephone | 909-982-4843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY40882
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License Number State | CA
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