Provider Demographics
NPI:1073834982
Name:CHEN, ROBERT C
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST AVE 26
Mailing Address - Street 2:RITE AID
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2312
Mailing Address - Country:US
Mailing Address - Phone:323-222-8876
Mailing Address - Fax:323-223-0144
Practice Address - Street 1:111 EAST AVE 26
Practice Address - Street 2:RITE AID
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2312
Practice Address - Country:US
Practice Address - Phone:323-222-8876
Practice Address - Fax:323-223-0144
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist