Provider Demographics
NPI:1619101714
Name:HONG, JAEWON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAEWON
Middle Name:
Last Name:HONG
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 1:7619 WEATHER WORN WAY UNIT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1441
Mailing Address - Country:US
Mailing Address - Phone:301-796-2013
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1058
Practice Address - Country:US
Practice Address - Phone:301-796-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28RI02291200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist