Provider Demographics
NPI:1144826967
Name:JUN, TINA YOOJIN (PHARMD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:YOOJIN
Last Name:JUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:YOOJIN
Other - Last Name:JANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7201
Mailing Address - Country:US
Mailing Address - Phone:815-444-4603
Mailing Address - Fax:
Practice Address - Street 1:177 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7201
Practice Address - Country:US
Practice Address - Phone:815-444-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist