Provider Demographics
NPI:1770245219
Name:BAEK, MINJUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINJUNG
Middle Name:
Last Name:BAEK
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 1:717 STATE ROUTE 9 NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8220
Mailing Address - Country:US
Mailing Address - Phone:425-249-4002
Mailing Address - Fax:
Practice Address - Street 1:717 STATE ROUTE 9 NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8220
Practice Address - Country:US
Practice Address - Phone:425-249-4002
Practice Address - Fax:425-249-4016
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61183349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist