Provider Demographics
NPI:1891177952
Name:UNG, JUSTINE (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:
Last Name:UNG
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SANTA ANITA ST STE G10
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1147
Mailing Address - Country:US
Mailing Address - Phone:626-281-6800
Mailing Address - Fax:626-281-6696
Practice Address - Street 1:207 S SANTA ANITA ST STE G10
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1147
Practice Address - Country:US
Practice Address - Phone:626-281-6800
Practice Address - Fax:626-281-6696
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65624183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3121954OtherBOARD CERTIFIED PHARMACOTHERAPY SPECIALIST (BCPS)