Provider Demographics
NPI:1396272928
Name:KWON, MIN S (PHARMD)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:S
Last Name:KWON
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 1:14347 MUSGROVE FARM CT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9535
Mailing Address - Country:US
Mailing Address - Phone:917-941-3550
Mailing Address - Fax:
Practice Address - Street 1:14347 MUSGROVE FARM CT
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9535
Practice Address - Country:US
Practice Address - Phone:917-941-3550
Practice Address - Fax:917-941-3550
Is Sole Proprietor?:No
Enumeration Date:2017-05-13
Last Update Date:2017-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist