Provider Demographics
NPI:1902187404
Name:NG, SHUK CHING MABLE
Entity Type:Individual
Prefix:
First Name:SHUK CHING
Middle Name:MABLE
Last Name:NG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1420
Mailing Address - Country:US
Mailing Address - Phone:847-615-2088
Mailing Address - Fax:847-615-2177
Practice Address - Street 1:12700 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1420
Practice Address - Country:US
Practice Address - Phone:847-615-2088
Practice Address - Fax:847-615-2177
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.036227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist