Provider Demographics
NPI:1326151689
Name:JEON, EUN S (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:EUN
Middle Name:S
Last Name:JEON
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3572
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-3572
Mailing Address - Country:US
Mailing Address - Phone:928-369-1774
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 73 MILE POST 342
Practice Address - Street 2:
Practice Address - City:WHITEIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111271835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy