Provider Demographics
NPI:1225631039
Name:CHUNG, STEFANIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 MOUNTAIN SPIRIT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7194
Mailing Address - Country:US
Mailing Address - Phone:562-279-6222
Mailing Address - Fax:
Practice Address - Street 1:7007 W ANN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1109
Practice Address - Country:US
Practice Address - Phone:562-279-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty