Provider Demographics
NPI:1013261171
Name:JEONG, JU RI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JU
Middle Name:RI
Last Name:JEONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JU
Other - Middle Name:
Other - Last Name:DELP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 46 BOX 457
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09469-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:202-604-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist