Healthcare Provider Details

I. General information

NPI: 1174844575
Provider Name (Legal Business Name): JOON H JUNG R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 06/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BUSTLETON AVE
PHILADELPHIA PA
19116-2516
US

IV. Provider business mailing address

11750 BUSTLETON AVE
PHILADELPHIA PA
19116-2516
US

V. Phone/Fax

Practice location:
  • Phone: 215-934-6221
  • Fax:
Mailing address:
  • Phone: 215-934-6221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP044117L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: