MEDICARE: DR. JUNGWON CHIN PHARM.D.

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
1	183500000X	Pharmacist	23767	MD

General Provider Information

NPI Number	:	1760855563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNGWON CHIN PHARM.D.

Provider Business Mailing Address
First Line	:	3142 NORMANDY WOODS DR
Second Line	:	APT F
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4221
Country	:	US
Telephone Number	:	919-280-6962
Fax Number	:

Provider Business Practice Location Address
First Line	:	10097 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3611
Country	:	US
Telephone Number	:	443-973-3339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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