Provider Demographics
NPI:1164857793
Name:PENG, CHIHUNG
Entity Type:Individual
Prefix:MR
First Name:CHIHUNG
Middle Name:
Last Name:PENG
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 1:8708 JUSTICE AVE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4575
Mailing Address - Country:US
Mailing Address - Phone:718-429-4411
Mailing Address - Fax:718-429-1741
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:PHARMACY
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-429-4411
Practice Address - Fax:718-429-1741
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist