Provider Demographics
NPI:1295339000
Name:CHU, GRACE (RPH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHU
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 1:1906 RESTON METRO PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5231
Mailing Address - Country:US
Mailing Address - Phone:703-234-2970
Mailing Address - Fax:571-397-3524
Practice Address - Street 1:1906 RESTON METRO PLZ STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5231
Practice Address - Country:US
Practice Address - Phone:703-234-2970
Practice Address - Fax:571-397-3524
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist