Provider Demographics
NPI:1639484157
Name:CHOW, RICKY (RPH)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:CHOW
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 1:5645 MAIN ST 1ST FL PHARMACY
Mailing Address - Street 2:OUTPATIENT PHARMACY 1ST FL
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-670-1728
Mailing Address - Fax:718-670-2489
Practice Address - Street 1:5645 MAIN ST 1ST FL PHARMACY
Practice Address - Street 2:OUTPATIENT PHARMACY 1ST FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-1728
Practice Address - Fax:718-670-2489
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03234300183500000X
NY055676-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist