Provider Demographics
NPI:1134672207
Name:JUNG, ANDREW HALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HALE
Last Name:JUNG
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 1:715 SUMTER CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1933
Mailing Address - Country:US
Mailing Address - Phone:818-642-3865
Mailing Address - Fax:
Practice Address - Street 1:5700 LINDERO CANYON RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4063
Practice Address - Country:US
Practice Address - Phone:818-597-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist