Basic Information
| Provider Information | |||||||||
| NPI: | 1740683267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REN | ||||||||
| FirstName: | CHA-CHI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45485 MIRAMAR WAY | ||||||||
| Address2: | |||||||||
| City: | CALIFORNIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206193191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017370611 | ||||||||
| FaxNumber: | 3017370613 | ||||||||
| Practice Location | |||||||||
| Address1: | 45485 MIRAMAR WAY | ||||||||
| Address2: | |||||||||
| City: | CALIFORNIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206193191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017370611 | ||||||||
| FaxNumber: | 3017370613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 09/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22475 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.