Healthcare Provider Details

I. General information

NPI: 1710314406
Provider Name (Legal Business Name): LAUREN ALLIA JUNG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 EAST DR. MARTIN LUTHER KING JR. DR.
MAXTON NC
28364
US

IV. Provider business mailing address

106 EAST DR. MARTIN LUTHER KING JR. DRIVE
MAXTON NC
28364
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-3096
  • Fax:
Mailing address:
  • Phone: 910-844-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23766
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: