Provider Demographics
NPI:1740561349
Name:AN, JUN BUM (RPH)
Entity Type:Individual
Prefix:MR
First Name:JUN BUM
Middle Name:
Last Name:AN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5913
Mailing Address - Country:US
Mailing Address - Phone:201-558-0094
Mailing Address - Fax:201-553-9495
Practice Address - Street 1:3333 PARK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5913
Practice Address - Country:US
Practice Address - Phone:201-558-0094
Practice Address - Fax:201-553-9495
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03110800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist