Provider Demographics
NPI:1376972398
Name:CHUANG, MARTIN ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALAN
Last Name:CHUANG
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 1:601 12TH ST FL 21
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3613
Mailing Address - Country:US
Mailing Address - Phone:510-607-3674
Mailing Address - Fax:
Practice Address - Street 1:601 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3613
Practice Address - Country:US
Practice Address - Phone:510-607-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68953OtherBOARD OF PHARMACY