Provider Demographics
NPI:1003103425
Name:OH, BUM-JUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BUM-JUN
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 E CHEYENNE DR APT 1121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1784
Mailing Address - Country:US
Mailing Address - Phone:217-722-4694
Mailing Address - Fax:
Practice Address - Street 1:4747 E ELLIOT RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1627
Practice Address - Country:US
Practice Address - Phone:480-496-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS018498OtherARIZONA PHARMACY LICENSE