Provider Demographics
NPI:1578904959
Name:CHONG, CHAE UN (RPH)
Entity Type:Individual
Prefix:
First Name:CHAE UN
Middle Name:
Last Name:CHONG
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 1:484 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1244
Mailing Address - Country:US
Mailing Address - Phone:202-210-1773
Mailing Address - Fax:973-693-4380
Practice Address - Street 1:625 EVANS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2008
Practice Address - Country:US
Practice Address - Phone:973-693-4380
Practice Address - Fax:973-693-4385
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02268600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist