Provider Demographics
NPI:1124416441
Name:CHUNG, EDWARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SPUR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-8080
Mailing Address - Country:US
Mailing Address - Phone:707-332-5964
Mailing Address - Fax:
Practice Address - Street 1:1315 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3419
Practice Address - Country:US
Practice Address - Phone:707-468-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist