Provider Demographics
NPI:1376955963
Name:SEO, MI JUNG
Entity Type:Individual
Prefix:
First Name:MI JUNG
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3302
Mailing Address - Country:US
Mailing Address - Phone:480-895-8369
Mailing Address - Fax:480-895-9665
Practice Address - Street 1:2995 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3302
Practice Address - Country:US
Practice Address - Phone:480-895-8369
Practice Address - Fax:480-895-9665
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist