Provider Demographics
NPI:1093029944
Name:KWON, YOUNG IL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG IL
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:YOUNG
Other - Middle Name:IL
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:91 MORGAN PL
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5008
Mailing Address - Country:US
Mailing Address - Phone:732-651-0069
Mailing Address - Fax:
Practice Address - Street 1:1700 N OLDEN AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-3102
Practice Address - Country:US
Practice Address - Phone:609-896-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03044500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist