Healthcare Provider Details

I. General information

NPI: 1649924937
Provider Name (Legal Business Name): JEIHUN KUACK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 SYKESVILLE RD
ELDERSBURG MD
21784-6000
US

IV. Provider business mailing address

6040 SYKESVILLE RD
ELDERSBURG MD
21784-6000
US

V. Phone/Fax

Practice location:
  • Phone: 410-781-4720
  • Fax: 410-552-3949
Mailing address:
  • Phone: 410-781-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28414
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: