Healthcare Provider Details

I. General information

NPI: 1083981542
Provider Name (Legal Business Name): AARON JUNK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MONOCACY BLVD
FREDERICK MD
21704-7256
US

IV. Provider business mailing address

1200 EDWARDS FERRY RD NE T-1874
LEESBURG VA
20176-3318
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-1482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012794
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number25710
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03321715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: