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General NPI Number Information
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NPI Number | 1033950878
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Entity Type | Individual
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Provider Name | DAGAM JEONG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 593 EDDY ST ANNEX BUILDING #416
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City | PROVIDENCE
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State | RI
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Zip | 02903
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Country | US
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Telephone | 401-606-2628
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Fax |
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Provider Business Mailing Address
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Address Line | 101 COUNTRY SIDE LN APT 202
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City | RIVERSIDE
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State | RI
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Zip | 02915-2566
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Country | US
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Telephone | 617-650-5915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 071493
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License Number State | NY
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