MEDICARE: DR. ILNAE CLARA NAMGUNG 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	RPH022634	GA
2	183500000X	Pharmacist	5302033635	MI

General Provider Information

NPI Number	:	1821387903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILNAE CLARA NAMGUNG PHARMD

Provider Business Mailing Address
First Line	:	2325 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-1753
Country	:	US
Telephone Number	:	770-497-4425
Fax Number	:	770-814-2327

Provider Business Practice Location Address
First Line	:	2325 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-1753
Country	:	US
Telephone Number	:	770-497-4425
Fax Number	:	770-814-2327

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

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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