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General NPI Number Information
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NPI Number | 1649164781
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Entity Type | Individual
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Provider Name | THOMAS JACKSON JUNG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2700 N BALLARD RD
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City | APPLETON
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State | WI
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Zip | 54911-8657
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Country | US
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Telephone | 920-996-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 CONNEMARA CT APT 13
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City | SHEBOYGAN
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State | WI
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Zip | 53083-1297
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Country | US
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Telephone | 262-515-8445
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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 | 22700-40
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License Number State | WI
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