Provider Demographics
NPI:1063840825
Name:GAK, EUN J (PHARMD)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:J
Last Name:GAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 BALBOA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5001
Mailing Address - Country:US
Mailing Address - Phone:818-831-2090
Mailing Address - Fax:818-831-2976
Practice Address - Street 1:10700 BALBOA BLVD # 101
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5001
Practice Address - Country:US
Practice Address - Phone:818-831-2090
Practice Address - Fax:818-831-2976
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist