Provider Demographics
NPI:1982012043
Name:CHEUNG, JONATHAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CHEUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 BROADWAY UNIT A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1567
Mailing Address - Country:US
Mailing Address - Phone:212-795-4909
Mailing Address - Fax:
Practice Address - Street 1:3875 BROADWAY UNIT A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-795-4909
Practice Address - Fax:212-795-2043
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist