Provider Demographics
NPI:1831672468
Name:SO, JEONG HO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEONG HO
Middle Name:
Last Name:SO
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 1:222 W EULALIA ST STE 212
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2850
Mailing Address - Country:US
Mailing Address - Phone:818-247-3266
Mailing Address - Fax:
Practice Address - Street 1:222 W EULALIA ST STE 212
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2850
Practice Address - Country:US
Practice Address - Phone:818-247-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist