Healthcare Provider Details

I. General information

NPI: 1952721334
Provider Name (Legal Business Name): JUNG EUN GWAK PHARM.D. BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549TH HOSPITAL CENTER/BDAACH
APO AP
96271-5245
US

IV. Provider business mailing address

PSC 444 BOX 1326
APO AP
96297-0014
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202211518
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60434870
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026851
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60434870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: