Provider Demographics
NPI:1861092207
Name:PHU, CHI (PHARMD)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:
Last Name:PHU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LEISURE DR
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1381
Mailing Address - Country:US
Mailing Address - Phone:815-690-1773
Mailing Address - Fax:
Practice Address - Street 1:3801 RUNNING BROOK FARM BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5425
Practice Address - Country:US
Practice Address - Phone:815-344-8137
Practice Address - Fax:815-344-8395
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist