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General NPI Number Information
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NPI Number | 1548825052
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Entity Type | Individual
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Provider Name | JONATHAN HEECHUL JU PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 62 WATER ST
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City | BROOKLYN
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State | NY
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Zip | 11201-1129
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Country | US
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Telephone | 347-689-2007
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Fax |
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Provider Business Mailing Address
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Address Line | 462 PEARL ST
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City | OCEANSIDE
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State | NY
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Zip | 11572-1931
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Country | US
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Telephone |
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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 | 064906
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License Number State | NY
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