Provider Demographics
NPI:1730965336
Name:JOE, JAE HEE
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:HEE
Last Name:JOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 DOGWOOD CIRCLE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3844
Mailing Address - Country:US
Mailing Address - Phone:470-354-9370
Mailing Address - Fax:
Practice Address - Street 1:3224 DOGWOOD CIRCLE SOUTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3844
Practice Address - Country:US
Practice Address - Phone:470-354-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030510A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist