Provider Demographics
NPI:1851790497
Name:HUNG, JASON (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HUNG
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 1:10408 FLOWERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6394
Mailing Address - Country:US
Mailing Address - Phone:301-873-5793
Mailing Address - Fax:
Practice Address - Street 1:12619 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5259
Practice Address - Country:US
Practice Address - Phone:301-540-1103
Practice Address - Fax:301-916-6509
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist