Provider Demographics
NPI:1750943049
Name:CHHAY, ANTHONY HONGTY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HONGTY
Last Name:CHHAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:HONGTY
Other - Last Name:CHHAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5016
Mailing Address - Country:US
Mailing Address - Phone:704-497-7295
Mailing Address - Fax:
Practice Address - Street 1:2011 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2744
Practice Address - Country:US
Practice Address - Phone:714-991-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist