Provider Demographics
NPI:1598396111
Name:PAK, ANDREW JUNGWOO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JUNGWOO
Last Name:PAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1119
Mailing Address - Country:US
Mailing Address - Phone:209-664-1121
Mailing Address - Fax:
Practice Address - Street 1:3100 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1119
Practice Address - Country:US
Practice Address - Phone:209-664-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist