Provider Demographics
NPI:1114056454
Name:CHUNG, RICHARD J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:CHUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OLD CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2073
Mailing Address - Country:US
Mailing Address - Phone:203-452-9447
Mailing Address - Fax:
Practice Address - Street 1:3129 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4223
Practice Address - Country:US
Practice Address - Phone:203-374-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist