Provider Demographics
NPI:1891761656
Name:JEONG, SHIGYONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHIGYONG
Middle Name:
Last Name:JEONG
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 1:8029 28TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4516
Mailing Address - Country:US
Mailing Address - Phone:206-782-1568
Mailing Address - Fax:
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4302
Practice Address - Country:US
Practice Address - Phone:206-343-4870
Practice Address - Fax:206-343-4884
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00048266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist