Provider Demographics
NPI:1326559063
Name:CHAE, PETER SOOAM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SOOAM
Last Name:CHAE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35751 GATEWAY DR UNIT I924
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6058
Mailing Address - Country:US
Mailing Address - Phone:909-538-5157
Mailing Address - Fax:
Practice Address - Street 1:72314 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2747
Practice Address - Country:US
Practice Address - Phone:760-469-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist