MEDICARE: MS. PHUONG HONG CHAU 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	051292922	IL
2	183500000X	Pharmacist	03328940	OH
3	183500000X	Pharmacist	28RI03351300	NJ

General Provider Information

NPI Number	:	1972883437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHUONG HONG CHAU PHARMD.

Provider Business Mailing Address
First Line	:	3943 W 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4145
Country	:	US
Telephone Number	:	513-646-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	3943 W 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4145
Country	:	US
Telephone Number	:	513-646-1633
Fax Number	:

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

Provider Enumeration Date	:	08/27/2011
Last Update Date	:	08/27/2011

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