Provider Demographics
NPI:1568503860
Name:UM, KARL HOON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:HOON
Last Name:UM
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 1:4779 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7944
Mailing Address - Country:US
Mailing Address - Phone:330-723-8089
Mailing Address - Fax:
Practice Address - Street 1:275 FOREST MEADOWS DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1632
Practice Address - Country:US
Practice Address - Phone:330-722-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-19245183500000X
NJRI02162700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist