Provider Demographics
NPI:1639502404
Name:BYUN, CONNIE GIN AH (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:GIN AH
Last Name:BYUN
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 1:9900 SOWDER VILLAGE SQ
Mailing Address - Street 2:T-2323
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5464
Mailing Address - Country:US
Mailing Address - Phone:703-257-6970
Mailing Address - Fax:703-257-6980
Practice Address - Street 1:9900 SOWDER VILLAGE SQ
Practice Address - Street 2:T-2323
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5464
Practice Address - Country:US
Practice Address - Phone:703-257-6970
Practice Address - Fax:703-257-6980
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist