Provider Demographics
NPI:1891307138
Name:JOO, ANTHONY SUNG JIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY SUNG JIN
Middle Name:
Last Name:JOO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUNG JIN
Other - Middle Name:
Other - Last Name:JOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:19266 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3366
Mailing Address - Country:US
Mailing Address - Phone:661-251-9433
Mailing Address - Fax:
Practice Address - Street 1:19266 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-3366
Practice Address - Country:US
Practice Address - Phone:661-251-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist