Provider Demographics
NPI:1790085173
Name:CHEN, AMY (RPH)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SINMAN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1600 FOOTHILL BLVD
Mailing Address - Street 2:VONS PHARMACY #2832
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3436
Mailing Address - Country:US
Mailing Address - Phone:909-593-2592
Mailing Address - Fax:909-392-4513
Practice Address - Street 1:1600 FOOTHILL BLVD
Practice Address - Street 2:VONS PHARMACY #2832
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3436
Practice Address - Country:US
Practice Address - Phone:909-593-2592
Practice Address - Fax:909-392-4513
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY48978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist