Provider Demographics
NPI:1972887651
Name:SHANG, CHUN-YI JENNIFER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHUN-YI JENNIFER
Middle Name:
Last Name:SHANG
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 1:1391 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7616
Mailing Address - Country:US
Mailing Address - Phone:636-861-1988
Mailing Address - Fax:636-861-9985
Practice Address - Street 1:1391 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7616
Practice Address - Country:US
Practice Address - Phone:636-861-1988
Practice Address - Fax:636-861-9985
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist