Provider Demographics
NPI:1467013862
Name:OH, JOHN KYOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KYOUNG
Last Name:OH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 SE MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3262
Mailing Address - Country:US
Mailing Address - Phone:224-475-5872
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4749
Practice Address - Country:US
Practice Address - Phone:781-566-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist