Provider Demographics
NPI:1629366224
Name:HONG, JOYCE
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27100 EUCALYPTUS AVE
Mailing Address - Street 2:T-2309
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4522
Mailing Address - Country:US
Mailing Address - Phone:951-571-8015
Mailing Address - Fax:951-571-8015
Practice Address - Street 1:27100 EUCALYPTUS AVE
Practice Address - Street 2:T-2309
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4522
Practice Address - Country:US
Practice Address - Phone:951-571-8015
Practice Address - Fax:951-571-8015
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist