Provider Demographics
NPI:1902153091
Name:JUNG, JEREMY DANIEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:JUNG
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 1:161 S SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4517
Mailing Address - Country:US
Mailing Address - Phone:650-360-5358
Mailing Address - Fax:650-583-8408
Practice Address - Street 1:161 S SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-360-5358
Practice Address - Fax:650-583-8408
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist