MEDICARE: RENEE CHEUNG RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	529181	NY

General Provider Information

NPI Number	:	1164754057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CHEUNG RPH

Provider Business Mailing Address
First Line	:	449 PORTION RD
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4579
Country	:	US
Telephone Number	:	631-737-1736
Fax Number	:	631-737-2879

Provider Business Practice Location Address
First Line	:	449 PORTION RD
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4579
Country	:	US
Telephone Number	:	631-737-1736
Fax Number	:	631-737-2879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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