Provider Demographics
NPI:1578732681
Name:CHEN, SHIH-YUAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHIH-YUAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1587 144TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3011
Mailing Address - Country:US
Mailing Address - Phone:718-989-2056
Mailing Address - Fax:516-932-3440
Practice Address - Street 1:336 N BROADWAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2031
Practice Address - Country:US
Practice Address - Phone:516-490-0117
Practice Address - Fax:516-932-3440
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044923OtherRPH