Provider Demographics
NPI:1518128370
Name:CHEUNG, CONNIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WALNUT ST
Mailing Address - Street 2:UNIT 216
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8600
Mailing Address - Country:US
Mailing Address - Phone:978-531-3450
Mailing Address - Fax:
Practice Address - Street 1:75 WALNUT ST
Practice Address - Street 2:UNIT 216
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8600
Practice Address - Country:US
Practice Address - Phone:978-531-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23981183500000X
FLPS33986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist