Provider Demographics
NPI:1760505689
Name:CHUNG, CLEMENT T (PHARMD , BCPS)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:T
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PHARMD , BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19864 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2763
Mailing Address - Country:US
Mailing Address - Phone:206-546-1976
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-251-5164
Practice Address - Fax:425-656-4085
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000391971835P1200X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology