Provider Demographics
NPI:1669579488
Name:JUNG, DANIEL TERENCE (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TERENCE
Last Name:JUNG
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 1:7826 DEL CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4550
Mailing Address - Country:US
Mailing Address - Phone:630-963-1566
Mailing Address - Fax:
Practice Address - Street 1:920 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3730
Practice Address - Country:US
Practice Address - Phone:312-569-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist