Provider Demographics
NPI:1356829378
Name:IM, EUNHO (RPH)
Entity Type:Individual
Prefix:
First Name:EUNHO
Middle Name:
Last Name:IM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1117
Mailing Address - Country:US
Mailing Address - Phone:650-941-8430
Mailing Address - Fax:650-941-9517
Practice Address - Street 1:2630 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1117
Practice Address - Country:US
Practice Address - Phone:650-941-8430
Practice Address - Fax:650-941-9517
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist