Provider Demographics
NPI:1174842983
Name:PAK, CHONG C. (RPH)
Entity Type:Individual
Prefix:
First Name:CHONG C.
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ALEX-CHONG
Other - Middle Name:
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:654 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6256
Mailing Address - Country:US
Mailing Address - Phone:201-664-6900
Mailing Address - Fax:201-664-9058
Practice Address - Street 1:654 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6256
Practice Address - Country:US
Practice Address - Phone:201-664-6900
Practice Address - Fax:201-664-9058
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02501400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist