Provider Demographics
NPI:1689993701
Name:HSUEH, HSING JERRY (RPH)
Entity Type:Individual
Prefix:
First Name:HSING
Middle Name:JERRY
Last Name:HSUEH
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 1:2797 S DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3513
Mailing Address - Country:US
Mailing Address - Phone:909-595-0912
Mailing Address - Fax:909-468-0872
Practice Address - Street 1:2797 S DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3513
Practice Address - Country:US
Practice Address - Phone:909-595-0912
Practice Address - Fax:909-468-0872
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist