Active NPI
Colleen Chung
- Pharmacist
- Antioch, CA
National Provider Identifier
1578097028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 62858
- Practice address
- 5601 Deer Valley Rd
Deer Valley Mob Pharmacy
Antioch, CA 94531-8577 - Phone
- (925) 813-6123
- NPI assigned
- Apr 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 62858 | CA | Primary |
Addresses
Primary practice location
5601 Deer Valley Rd
Deer Valley Mob Pharmacy
Antioch, CA 94531-8577
Mailing address
5601 Deer Valley Rd
Deer Valley Mob Pharmacy
Antioch, CA 94531-8577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62858 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491868800000",
"number": "1578097028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5601 DEER VALLEY RD",
"address_2": "DEER VALLEY MOB PHARMACY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 DEER VALLEY RD",
"address_2": "DEER VALLEY MOB PHARMACY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318577",
"telephone_number": "925-813-6123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "COLLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-11",
"last_updated": "2017-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "62858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.