Provider Demographics
NPI:1700965894
Name:CHUNG, BANG QUAN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BANG
Middle Name:QUAN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 GRAND ST
Mailing Address - Street 2:BUY RITE PHARMACY FOUR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4286
Mailing Address - Country:US
Mailing Address - Phone:212-625-9505
Mailing Address - Fax:212-625-9509
Practice Address - Street 1:215 GRAND ST
Practice Address - Street 2:BUY RITE PHARMACY FOUR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4286
Practice Address - Country:US
Practice Address - Phone:212-625-9505
Practice Address - Fax:212-625-9509
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3352363OtherNCPDP