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NPI Code Detail

MEDICARE: HYUNJAE OH PHARMD

MEDICARE: HYUNJAE OH PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist61284TX

General Provider Information

NPI Number : 1639766439
Entity Type Code : Individual
Provider Name (Legal Business Name) : HYUNJAE OH PHARMD
Provider Business Mailing Address
First Line : 1721 MONTCLAIR DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-1905
Country : US
Telephone Number : 817-422-7991
Fax Number :
Provider Business Practice Location Address
First Line : 3308 DEEN RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76106-6524
Country : US
Telephone Number : 817-702-7129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2020
Last Update Date : 12/28/2020

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Directions to “ HYUNJAE OH PHARMD” Practice Location

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