Provider Demographics
NPI:1760731483
Name:CHUNG, ALICE KEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:KEY
Last Name:CHUNG
Suffix:
Gender:F
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:P.O. BOX 840688
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0688
Mailing Address - Country:US
Mailing Address - Phone:909-796-7171
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:1127 BRYN MAWR AVE
Practice Address - Street 2:STE A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4558
Practice Address - Country:US
Practice Address - Phone:909-796-7171
Practice Address - Fax:909-799-4364
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist