Provider Demographics
NPI:1366780108
Name:CHEUNG, HENRY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:CHEUNG
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 1:7429 COLUMNS CIR
Mailing Address - Street 2:APT 302
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3689
Mailing Address - Country:US
Mailing Address - Phone:239-789-7762
Mailing Address - Fax:
Practice Address - Street 1:2480 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3943
Practice Address - Country:US
Practice Address - Phone:727-937-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS49352OtherPHARMACIST LICENSE NUMBER