Provider Demographics
NPI:1760765341
Name:CHUNG, KEVIN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:CHUNG
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 1:143 TWIN BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-7511
Mailing Address - Country:US
Mailing Address - Phone:401-463-9859
Mailing Address - Fax:401-781-5045
Practice Address - Street 1:143 TWIN BIRCH DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-7511
Practice Address - Country:US
Practice Address - Phone:401-463-9859
Practice Address - Fax:401-781-5045
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist