Healthcare Provider Details

I. General information

NPI: 1194929448
Provider Name (Legal Business Name): JAE CHOI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 FISHERS LN 10C-03
ROCKVILLE MD
20857-0001
US

IV. Provider business mailing address

3330 SONIA TRL APT 206
ELLICOTT CITY MD
21043-3589
US

V. Phone/Fax

Practice location:
  • Phone: 301-443-1603
  • Fax:
Mailing address:
  • Phone: 410-903-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18158
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: