Provider Demographics
NPI:1629347893
Name:BAE-HERMANN, JINHEE (RPH PHD)
Entity Type:Individual
Prefix:MS
First Name:JINHEE
Middle Name:
Last Name:BAE-HERMANN
Suffix:
Gender:F
Credentials:RPH PHD
Other - Prefix:MS
Other - First Name:JINHEE
Other - Middle Name:
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3835
Mailing Address - Country:US
Mailing Address - Phone:920-457-5656
Mailing Address - Fax:920-457-1731
Practice Address - Street 1:2702 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3835
Practice Address - Country:US
Practice Address - Phone:920-457-5656
Practice Address - Fax:920-457-1731
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12647-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist