Provider Demographics
NPI:1801203153
Name:CHEUNG, CICI CHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CICI
Middle Name:CHAN
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 9TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4288
Mailing Address - Country:US
Mailing Address - Phone:510-763-3282
Mailing Address - Fax:510-763-8077
Practice Address - Street 1:388 9TH ST STE 108
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4288
Practice Address - Country:US
Practice Address - Phone:510-763-3282
Practice Address - Fax:510-763-8077
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist