Provider Demographics
NPI:1326358045
Name:CHU, STANTON RICKLAND (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STANTON
Middle Name:RICKLAND
Last Name:CHU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 OTAY LAKES RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:619-656-6944
Mailing Address - Fax:619-656-3869
Practice Address - Street 1:2230 OTAY LAKES RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:619-656-6944
Practice Address - Fax:619-656-3869
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist