Provider Demographics
NPI:1821387903
Name:NAMGUNG, ILNAE CLARA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ILNAE
Middle Name:CLARA
Last Name:NAMGUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1753
Mailing Address - Country:US
Mailing Address - Phone:770-497-4425
Mailing Address - Fax:770-814-2327
Practice Address - Street 1:2325 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1753
Practice Address - Country:US
Practice Address - Phone:770-497-4425
Practice Address - Fax:770-814-2327
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022634183500000X
MI5302033635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist