MEDICARE: DR. CHARLOTTE JUNG 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
1	183500000X	Pharmacist	PS61657	FL

General Provider Information

NPI Number	:	1679160881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE JUNG PHARMD

Provider Business Mailing Address
First Line	:	1851 LPGA BLVD APT 12301
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 BEACH VILLAGE DR
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-3063
Country	:	US
Telephone Number	:	386-517-2781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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