Provider Demographics
NPI:1497934574
Name:CHUNG, DOUGLAS CHU (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHU
Last Name:CHUNG
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 1:148 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4321
Mailing Address - Country:US
Mailing Address - Phone:860-657-8014
Mailing Address - Fax:
Practice Address - Street 1:148 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-657-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist