Provider Demographics
NPI:1972962322
Name:CHIEM, ROGER (RPH)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:CHIEM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N NICHOLSON AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-2302
Mailing Address - Country:US
Mailing Address - Phone:310-845-6132
Mailing Address - Fax:
Practice Address - Street 1:5525 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1047
Practice Address - Country:US
Practice Address - Phone:310-642-0325
Practice Address - Fax:310-642-2655
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist