Provider Demographics
NPI:1104532597
Name:CHUNG, LAUREN RANDALL (PHARMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RANDALL
Last Name:CHUNG
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 1:25 BIRCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3585
Mailing Address - Country:US
Mailing Address - Phone:800-950-2688
Mailing Address - Fax:
Practice Address - Street 1:25 BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3585
Practice Address - Country:US
Practice Address - Phone:800-950-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-100566183500000X
MAPH27250183500000X
NV23308183500000X
NJ28RI03197500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist