Provider Demographics
NPI:1437521051
Name:CHA, CHUL HO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHUL HO
Middle Name:
Last Name:CHA
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 1:330 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1703
Mailing Address - Country:US
Mailing Address - Phone:201-592-9888
Mailing Address - Fax:201-592-9880
Practice Address - Street 1:330 BROAD AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1703
Practice Address - Country:US
Practice Address - Phone:201-592-9888
Practice Address - Fax:201-592-9880
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03616400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03616400OtherNEW JERSEY BOARD OF PHARMACY