Provider Demographics
NPI:1134552409
Name:JUNG, JESSIE SONNA (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:SONNA
Last Name:JUNG
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 1:7606 MCCRIMMON PKWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-0847
Mailing Address - Country:US
Mailing Address - Phone:919-244-3228
Mailing Address - Fax:
Practice Address - Street 1:3601 DAVIS DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8845
Practice Address - Country:US
Practice Address - Phone:919-468-6880
Practice Address - Fax:919-468-6494
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920172Medicaid
NC0282936138Medicare NSC
NC0920172Medicaid
NCPHC049Medicare PIN