Provider Demographics
NPI:1598174567
Name:CHUN, SAMUEL K (PHARM D)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:CHUN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 VILLA WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3001
Mailing Address - Country:US
Mailing Address - Phone:714-614-1628
Mailing Address - Fax:
Practice Address - Street 1:4001 HALLMARK PKWY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1876
Practice Address - Country:US
Practice Address - Phone:909-880-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist