Provider Demographics
NPI:1730476888
Name:JUNG, THOMAS (THOMAS JUNG)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:THOMAS JUNG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27008 92ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-5343
Mailing Address - Country:US
Mailing Address - Phone:360-629-0662
Mailing Address - Fax:360-629-0652
Practice Address - Street 1:27008 92ND AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-5343
Practice Address - Country:US
Practice Address - Phone:360-629-0662
Practice Address - Fax:360-629-0652
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6027098Medicaid
WA6027098Medicaid