Provider Demographics
NPI:1295058428
Name:CHUNG, SUSAN KAY (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:CHUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35100 ENCHANTED PKWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8314
Mailing Address - Country:US
Mailing Address - Phone:253-874-4431
Mailing Address - Fax:
Practice Address - Street 1:35100 ENCHANTED PKWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8314
Practice Address - Country:US
Practice Address - Phone:253-874-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist