Provider Demographics
NPI:1972659233
Name:CHUNG PHARMACY INC
Entity Type:Organization
Organization Name:CHUNG PHARMACY INC
Other - Org Name:CHUNG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:253-584-2484
Mailing Address - Street 1:9122 S TACOMA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4406
Mailing Address - Country:US
Mailing Address - Phone:253-584-2484
Mailing Address - Fax:253-584-6094
Practice Address - Street 1:9122 S TACOMA WAY STE 104
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98499-4406
Practice Address - Country:US
Practice Address - Phone:253-584-2484
Practice Address - Fax:253-584-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000049073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6020689Medicaid