Provider Demographics
NPI:1881108009
Name:BLACK, CHUE LEE (PHARM D, CPP)
Entity type:Individual
Prefix:
First Name:CHUE
Middle Name:LEE
Last Name:BLACK
Suffix:
Gender:F
Credentials:PHARM D, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7095
Mailing Address - Country:US
Mailing Address - Phone:828-320-9648
Mailing Address - Fax:
Practice Address - Street 1:3000 BETHESDA PL STE 104
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3323
Practice Address - Country:US
Practice Address - Phone:336-293-4107
Practice Address - Fax:949-577-4324
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19234183500000X
NC100011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist