MEDICARE: MR. DAVID CHIU PHARMACIST

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	28RI02860000	NJ
2	183500000X	Pharmacist	0499881	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28RI02860000	OTHER	NJ	NJ STATE LICENSE
2	0499881	OTHER	NY	NY STATE LICENSE

General Provider Information

NPI Number	:	1619155843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID CHIU PHARMACIST

Provider Business Mailing Address
First Line	:	1417 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-6307
Country	:	US
Telephone Number	:	201-864-5617
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-6307
Country	:	US
Telephone Number	:	201-864-5617
Fax Number	:	201-864-5623

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	06/09/2008

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Directions to “ MR. DAVID CHIU PHARMACIST” Practice Location

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