Provider Demographics
NPI:1134882293
Name:CHEN, JUSTIN (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 PARK TERRACE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5653
Mailing Address - Country:US
Mailing Address - Phone:805-497-8258
Mailing Address - Fax:
Practice Address - Street 1:4333 PARK TERRACE DR STE 160
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5653
Practice Address - Country:US
Practice Address - Phone:805-497-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist