Healthcare Provider Details

I. General information

NPI: 1134591308
Provider Name (Legal Business Name): HALLIE JUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N EL CAMINO REAL
ENCINITAS CA
92024-2802
US

IV. Provider business mailing address

129 N EL CAMINO REAL
ENCINITAS CA
92024-2802
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-2269
  • Fax: 760-942-6722
Mailing address:
  • Phone: 760-942-2269
  • Fax: 760-942-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: