Provider Demographics
NPI:1962892182
Name:CHEN, ALBERT
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 WEITZEL ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547
Mailing Address - Country:US
Mailing Address - Phone:970-416-6125
Mailing Address - Fax:970-416-6115
Practice Address - Street 1:4705 WEITZEL ST
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547
Practice Address - Country:US
Practice Address - Phone:970-416-6125
Practice Address - Fax:970-416-6115
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist