Provider Demographics
NPI:1487192902
Name:KWON, CHUNG IN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHUNG IN
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 UNDERCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1454
Mailing Address - Country:US
Mailing Address - Phone:347-882-5778
Mailing Address - Fax:
Practice Address - Street 1:116 HUGH J GRANT CIR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5065
Practice Address - Country:US
Practice Address - Phone:718-823-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist