Provider Demographics
NPI:1326559246
Name:KIM, JUNGRAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUNGRAN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:JUNGRAN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2 MAIN ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1704
Mailing Address - Country:US
Mailing Address - Phone:206-354-4863
Mailing Address - Fax:
Practice Address - Street 1:2 MAIN ST UNIT 111
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1704
Practice Address - Country:US
Practice Address - Phone:206-354-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03892500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist