Provider Demographics
NPI:1629179189
Name:KOO, JUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:KOO
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:PO BOX 32861
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-446-0903
Mailing Address - Fax:
Practice Address - Street 1:251 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7103
Practice Address - Country:US
Practice Address - Phone:704-446-0903
Practice Address - Fax:704-446-0968
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist