Provider Demographics
NPI:1013192095
Name:CHOW, PAULINE YUEN WAN
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:YUEN WAN
Last Name:CHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15802 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1940
Mailing Address - Country:US
Mailing Address - Phone:718-380-8259
Mailing Address - Fax:
Practice Address - Street 1:15802 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1940
Practice Address - Country:US
Practice Address - Phone:718-380-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02830284Medicaid