Provider Demographics
NPI:1578863247
Name:HA, JANE YOUNGJU (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:YOUNGJU
Last Name:HA
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 1:3850 VALLEY CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2331
Mailing Address - Country:US
Mailing Address - Phone:858-793-4667
Mailing Address - Fax:
Practice Address - Street 1:3850 VALLEY CENTRE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2331
Practice Address - Country:US
Practice Address - Phone:760-353-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist