Provider Demographics
NPI:1528190543
Name:LEUNG, SHIRLEY (RPH)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:LEUNG
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 1:1512 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2172
Mailing Address - Country:US
Mailing Address - Phone:646-289-2990
Mailing Address - Fax:
Practice Address - Street 1:5564 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5216
Practice Address - Country:US
Practice Address - Phone:718-548-5884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist