MEDICARE: DR. JACKSON CHEUNG PHARMD

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	052005	NY

General Provider Information

NPI Number	:	1639350226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKSON CHEUNG PHARMD

Provider Business Mailing Address
First Line	:	1490 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4502
Country	:	US
Telephone Number	:	212-410-2508
Fax Number	:	212-410-6554

Provider Business Practice Location Address
First Line	:	1490 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4502
Country	:	US
Telephone Number	:	212-410-2508
Fax Number	:	212-410-6554

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

Provider Enumeration Date	:	11/25/2007
Last Update Date	:	05/26/2010

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Directions to “ DR. JACKSON CHEUNG PHARMD” Practice Location

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