Healthcare Provider Details

I. General information

NPI: 1619729878
Provider Name (Legal Business Name): BO RAM KEUM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 BERGEN BLVD
FORT LEE NJ
07024-2116
US

IV. Provider business mailing address

2400 HUDSON TER APT 4J
FORT LEE NJ
07024-3507
US

V. Phone/Fax

Practice location:
  • Phone: 201-482-0801
  • Fax:
Mailing address:
  • Phone: 617-378-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04361800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: