Provider Demographics
NPI:1417143637
Name:BAE, HYUN-JUNG JESSICA (RPH)
Entity Type:Individual
Prefix:MS
First Name:HYUN-JUNG
Middle Name:JESSICA
Last Name:BAE
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 1:8629 120TH AVE NE
Mailing Address - Street 2:COSTCO PHARMACY
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5822
Mailing Address - Country:US
Mailing Address - Phone:425-822-0414
Mailing Address - Fax:425-822-0811
Practice Address - Street 1:8629 120TH AVE NE
Practice Address - Street 2:COSTCO PHARMACY
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5822
Practice Address - Country:US
Practice Address - Phone:425-822-0414
Practice Address - Fax:425-822-0811
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist