Provider Demographics
NPI:1306168729
Name:CHON, GRACE (RPH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CHON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WEYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1409
Mailing Address - Country:US
Mailing Address - Phone:917-235-7171
Mailing Address - Fax:914-235-6626
Practice Address - Street 1:16 WEYMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1409
Practice Address - Country:US
Practice Address - Phone:917-235-7171
Practice Address - Fax:914-235-6626
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY54210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist