Provider Demographics
NPI:1619352788
Name:KWON, JANICE J (PHARM D)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:J
Last Name:KWON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-652-0492
Mailing Address - Fax:
Practice Address - Street 1:2431 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9067
Practice Address - Country:US
Practice Address - Phone:718-652-0492
Practice Address - Fax:718-654-2596
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist