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NPI Code Detail

MEDICARE: DONG JOO CHA PHARM. D

MEDICARE: DONG JOO 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
1183500000XPharmacist056250NY

General Provider Information

NPI Number : 1952684656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONG JOO CHA PHARM. D
Provider Business Mailing Address
First Line : 57 11 CLOVERDALE BLVD
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364
Country : US
Telephone Number : 917-547-2925
Fax Number :
Provider Business Practice Location Address
First Line : 134 GREAT EAST NECK RD
Second Line :
City : WEST BABYLON
State : NY
Zip : 11704-8027
Country : US
Telephone Number : 631-321-3850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2011
Last Update Date : 09/20/2011

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