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General NPI Number Information
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NPI Number | 1629437306
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Entity Type | Individual
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Provider Name | BENJAMIN JARED JUNG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 611 N SAINT JOSEPH AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-1832
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Country | US
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Telephone | 715-387-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 317 S 52ND AVE
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City | WAUSAU
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State | WI
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Zip | 54401-8069
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Country | US
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Telephone | 715-212-5022
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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 | 15772
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License Number State | WI
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