Provider Demographics
NPI:1750529863
Name:BARK, JONG HOON (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JONG
Middle Name:HOON
Last Name:BARK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 161ST ST
Mailing Address - Street 2:#2FL.
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3652
Mailing Address - Country:US
Mailing Address - Phone:646-591-9773
Mailing Address - Fax:
Practice Address - Street 1:1916 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1605
Practice Address - Country:US
Practice Address - Phone:718-239-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist