Provider Demographics
NPI:1104126143
Name:CHHUN, EAB-HONG (RPH)
Entity type:Individual
Prefix:MR
First Name:EAB-HONG
Middle Name:
Last Name:CHHUN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 N ARIZONA BLVD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-3214
Mailing Address - Country:US
Mailing Address - Phone:520-723-5552
Mailing Address - Fax:520-723-5551
Practice Address - Street 1:1449 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3214
Practice Address - Country:US
Practice Address - Phone:520-723-5552
Practice Address - Fax:520-723-5551
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist