Provider Demographics
NPI:1639350226
Name:CHEUNG, JACKSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4502
Mailing Address - Country:US
Mailing Address - Phone:212-410-2508
Mailing Address - Fax:212-410-6554
Practice Address - Street 1:1490 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4502
Practice Address - Country:US
Practice Address - Phone:212-410-2508
Practice Address - Fax:212-410-6554
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist