Provider Demographics
NPI:1457955908
Name:NOH, HEESEUNG
Entity type:Individual
Prefix:
First Name:HEESEUNG
Middle Name:
Last Name:NOH
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 1:1107 SW 83RD WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7043
Mailing Address - Country:US
Mailing Address - Phone:352-359-4424
Mailing Address - Fax:
Practice Address - Street 1:15174 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-8602
Practice Address - Country:US
Practice Address - Phone:386-462-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist