Provider Demographics
NPI:1467035691
Name:HAN, JISUP (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JISUP
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4469
Mailing Address - Country:US
Mailing Address - Phone:201-224-8877
Mailing Address - Fax:201-224-8871
Practice Address - Street 1:455 LIVINGSTON ST STE 4
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1360
Practice Address - Country:US
Practice Address - Phone:201-272-6224
Practice Address - Fax:201-272-6225
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03614100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist