Provider Demographics
NPI:1649791609
Name:CHOI, RICHARD YOUNG (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:YOUNG
Last Name:CHOI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:RICHARD
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:69 DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3921 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1538
Practice Address - Country:US
Practice Address - Phone:212-928-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03302200183500000X
NY054298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist