Basic Information
| Provider Information | |||||||||
| NPI: | 1902150451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM. D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 CLENT RD. | ||||||||
| Address2: | APT. 2P | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110213462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165477884 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1829 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115102453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163787645 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2012 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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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 | 057149 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.