Healthcare Provider Details

I. General information

NPI: 1164907838
Provider Name (Legal Business Name): SANGWON JEON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 LIMESTONE RD
WILMINGTON DE
19808-1928
US

IV. Provider business mailing address

5529 LIMERIC CIR APT 41
WILMINGTON DE
19808-3417
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-2286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0005317
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: