Provider Demographics
NPI:1689028482
Name:SOH, JUNG-WON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JUNG-WON
Middle Name:
Last Name:SOH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30003 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1566
Mailing Address - Country:US
Mailing Address - Phone:248-904-6444
Mailing Address - Fax:
Practice Address - Street 1:539 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1952
Practice Address - Country:US
Practice Address - Phone:248-414-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist