=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265865950
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOOJIN JUN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2013
-----------------------------------------------------
Last Update Date | 08/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4469 HUNTINGTON BLVD
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60192-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-778-7709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4469 HUNTINGTON BLVD
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60192-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-778-7709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 17210-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------