Provider Demographics
NPI:1558658229
Name:SHON, JI EUN
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:EUN
Last Name:SHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 REISTERSTOWN RD
Mailing Address - Street 2:T-1541
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2907
Mailing Address - Country:US
Mailing Address - Phone:410-486-4190
Mailing Address - Fax:410-486-4190
Practice Address - Street 1:1737 REISTERSTOWN RD
Practice Address - Street 2:T-1541
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2907
Practice Address - Country:US
Practice Address - Phone:410-486-4190
Practice Address - Fax:410-486-4190
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist