Provider Demographics
NPI:1649981507
Name:YOO, JINCHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JINCHAN
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 OAK ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1835
Mailing Address - Country:US
Mailing Address - Phone:716-517-8640
Mailing Address - Fax:
Practice Address - Street 1:450B BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-3631
Practice Address - Country:US
Practice Address - Phone:201-947-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI068400-01183500000X
NJ28RI04221200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist