Provider Demographics
NPI:1972883437
Name:CHAU, PHUONG HONG (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:PHUONG
Middle Name:HONG
Last Name:CHAU
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 1:3943 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4145
Mailing Address - Country:US
Mailing Address - Phone:513-646-1633
Mailing Address - Fax:
Practice Address - Street 1:3943 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4145
Practice Address - Country:US
Practice Address - Phone:513-646-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292922183500000X
OH03328940183500000X
NJ28RI03351300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist