Provider Demographics
NPI:1902119456
Name:WU, CHO-MAN (R PH)
Entity Type:Individual
Prefix:
First Name:CHO-MAN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2543
Mailing Address - Country:US
Mailing Address - Phone:631-286-9491
Mailing Address - Fax:631-286-9224
Practice Address - Street 1:2950 HORSEBLOCK RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2543
Practice Address - Country:US
Practice Address - Phone:631-286-9491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist