Provider Demographics
NPI:1902146897
Name:CHENG, ALICE C (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:CHENG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19300 S HAMILTON AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4411
Mailing Address - Country:US
Mailing Address - Phone:310-771-0619
Mailing Address - Fax:310-771-0621
Practice Address - Street 1:19300 S HAMILTON AVE STE 170
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4411
Practice Address - Country:US
Practice Address - Phone:310-771-0619
Practice Address - Fax:310-771-0621
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52009183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist