Provider Demographics
NPI:1376026021
Name:FU, CHAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAO
Middle Name:
Last Name:FU
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 1:234 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2053
Mailing Address - Country:US
Mailing Address - Phone:402-281-6849
Mailing Address - Fax:
Practice Address - Street 1:450 N WILBUR AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2254
Practice Address - Country:US
Practice Address - Phone:402-281-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60863174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60863174OtherWASHINGTON STATE DEPARTMENT OF HEALTH