Provider Demographics
NPI:1659974541
Name:OH, CHUL JOONG (RPH)
Entity Type:Individual
Prefix:
First Name:CHUL JOONG
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1200 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3318
Mailing Address - Country:US
Mailing Address - Phone:703-777-8059
Mailing Address - Fax:571-442-5299
Practice Address - Street 1:1200 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3318
Practice Address - Country:US
Practice Address - Phone:703-777-8059
Practice Address - Fax:571-442-5299
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist