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General NPI Number Information
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NPI Number | 1952919367
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Entity Type | Individual
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Provider Name | GRACE S CHUNG
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 2275 N MAYFAIR RD
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City | WAUWATOSA
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State | WI
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Zip | 53226-2207
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Country | US
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Telephone | 414-774-4821
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 N MAYFAIR RD UNIT 203
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City | WAUWATOSA
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State | WI
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Zip | 53226-2228
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Country | US
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Telephone | 608-770-8269
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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 | 20343
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License Number State | WI
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