Provider Demographics
NPI:1508637661
Name:CHUNG, MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 INTERLAKE AVE N UNIT 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3342
Mailing Address - Country:US
Mailing Address - Phone:909-530-9697
Mailing Address - Fax:
Practice Address - Street 1:2324 EASTLAKE AVE E STE 400A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3345
Practice Address - Country:US
Practice Address - Phone:206-838-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61452683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist