Provider Demographics
NPI:1619155843
Name:CHIU, DAVID (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CHIU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6307
Mailing Address - Country:US
Mailing Address - Phone:201-864-5617
Mailing Address - Fax:
Practice Address - Street 1:1417 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6307
Practice Address - Country:US
Practice Address - Phone:201-864-5617
Practice Address - Fax:201-864-5623
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02860000183500000X
NY0499881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02860000OtherNJ STATE LICENSE
NY0499881OtherNY STATE LICENSE