Provider Demographics
NPI:1083714000
Name:CHUNG, HYANGSOOK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HYANGSOOK
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 COMMONWEALTH AVE
Mailing Address - Street 2:U-12A
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5173
Mailing Address - Country:US
Mailing Address - Phone:857-364-4317
Mailing Address - Fax:857-364-2155
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4317
Practice Address - Fax:857-364-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist