MEDICARE: CHRISTINE CHA PHARM.D.

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	055593	NY

General Provider Information

NPI Number	:	1780962118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE CHA PHARM.D.

Provider Business Mailing Address
First Line	:	5359 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5359 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:	718-298-2222
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	07/16/2015

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