Provider Demographics
NPI:1578801882
Name:CHUNG, JOHN MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:CHUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-8618
Mailing Address - Country:US
Mailing Address - Phone:503-359-3103
Mailing Address - Fax:503-359-3341
Practice Address - Street 1:2200 BASELINE ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-8618
Practice Address - Country:US
Practice Address - Phone:503-359-3103
Practice Address - Fax:503-359-3341
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR75441835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist