Provider Demographics
NPI:1649924937
Name:KUACK, JEIHUN (RPH)
Entity type:Individual
Prefix:DR
First Name:JEIHUN
Middle Name:
Last Name:KUACK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 SYKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6000
Mailing Address - Country:US
Mailing Address - Phone:410-781-4720
Mailing Address - Fax:
Practice Address - Street 1:6040 SYKESVILLE RD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6000
Practice Address - Country:US
Practice Address - Phone:410-781-4720
Practice Address - Fax:410-552-3949
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist