Provider Demographics
NPI:1568215028
Name:KWON, JOELLE JUNGHYUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:JUNGHYUN
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 1:101 MONMOUTH ST APT 415
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5612
Mailing Address - Country:US
Mailing Address - Phone:720-291-7812
Mailing Address - Fax:
Practice Address - Street 1:341 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2265
Practice Address - Country:US
Practice Address - Phone:617-556-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH997199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist