Provider Demographics
NPI:1902413628
Name:DOO, JIHEE
Entity Type:Individual
Prefix:
First Name:JIHEE
Middle Name:
Last Name:DOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AVALON DR UNIT 5104
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4240
Mailing Address - Country:US
Mailing Address - Phone:617-458-0220
Mailing Address - Fax:
Practice Address - Street 1:416 WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-1831
Practice Address - Country:US
Practice Address - Phone:617-541-0310
Practice Address - Fax:617-445-0624
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist