Provider Demographics
NPI:1467164053
Name:HAN, JEONGSEOK (RPH)
Entity Type:Individual
Prefix:
First Name:JEONGSEOK
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277
Mailing Address - Country:US
Mailing Address - Phone:508-335-3990
Mailing Address - Fax:
Practice Address - Street 1:1343 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:THOMPSON
Practice Address - State:CT
Practice Address - Zip Code:06277
Practice Address - Country:US
Practice Address - Phone:508-335-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist