Healthcare Provider Details

I. General information

NPI: 1134552409
Provider Name (Legal Business Name): JESSIE SONNA JUNG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 DAVIS DR
MORRISVILLE NC
27560-8845
US

IV. Provider business mailing address

7606 MCCRIMMON PKWY
CARY NC
27519-0847
US

V. Phone/Fax

Practice location:
  • Phone: 919-468-6880
  • Fax: 919-468-6494
Mailing address:
  • Phone: 919-244-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: