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NPI Code Detail

MEDICARE: JUNG KOO PHARMD

MEDICARE: JUNG KOO PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist13966NC

General Provider Information

NPI Number : 1629179189
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUNG KOO PHARMD
Provider Business Mailing Address
First Line : PO BOX 32861
Second Line :
City : CHARLOTTE
State : NC
Zip : 28232-2861
Country : US
Telephone Number : 704-446-0903
Fax Number :
Provider Business Practice Location Address
First Line : 251 EASTWAY DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-7103
Country : US
Telephone Number : 704-446-0903
Fax Number : 704-446-0968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 11/01/2007

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Directions to “ JUNG KOO PHARMD” Practice Location

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