Healthcare Provider Details

I. General information

NPI: 1033699194
Provider Name (Legal Business Name): JIN RONG HUANG PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WASHINGTON AVE
PHILADELPHIA PA
19147-4716
US

IV. Provider business mailing address

801 WASHINGTON AVE
PHILADELPHIA PA
19147-4716
US

V. Phone/Fax

Practice location:
  • Phone: 347-263-9854
  • Fax:
Mailing address:
  • Phone: 347-263-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452345
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: