Provider Demographics
NPI:1902081607
Name:CHEUNG, MARY H (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:CHEUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4510
Mailing Address - Country:US
Mailing Address - Phone:212-343-1517
Mailing Address - Fax:646-292-5191
Practice Address - Street 1:173 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4510
Practice Address - Country:US
Practice Address - Phone:212-343-1517
Practice Address - Fax:646-292-5191
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052642Medicaid