Provider Demographics
NPI:1750981643
Name:CHUBA, LEUNGA S
Entity type:Individual
Prefix:
First Name:LEUNGA
Middle Name:S
Last Name:CHUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-2193
Mailing Address - Country:US
Mailing Address - Phone:816-776-8577
Mailing Address - Fax:816-776-8764
Practice Address - Street 1:908 WALTON WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2193
Practice Address - Country:US
Practice Address - Phone:816-776-8577
Practice Address - Fax:816-776-8764
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist