Provider Demographics
NPI:1942947759
Name:CHUNG, JONG WON (RPH, CCP)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:WON
Last Name:CHUNG
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MADDAKET
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3136
Mailing Address - Country:US
Mailing Address - Phone:908-418-6544
Mailing Address - Fax:
Practice Address - Street 1:46 MADDAKET
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-3136
Practice Address - Country:US
Practice Address - Phone:908-418-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02904000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty