Provider Demographics
NPI:1730613456
Name:HONG, NAE (RPH)
Entity type:Individual
Prefix:
First Name:NAE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 E LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4415
Mailing Address - Country:US
Mailing Address - Phone:951-245-5540
Mailing Address - Fax:951-245-9540
Practice Address - Street 1:2091 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4415
Practice Address - Country:US
Practice Address - Phone:951-245-5540
Practice Address - Fax:951-245-9540
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist