Provider Demographics
NPI:1801486733
Name:CHOI, JEONGWON
Entity type:Individual
Prefix:
First Name:JEONGWON
Middle Name:
Last Name:CHOI
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 1:1149 BENJAMIN FRANKLIN HWY WEST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518
Mailing Address - Country:US
Mailing Address - Phone:610-385-4300
Mailing Address - Fax:
Practice Address - Street 1:1149 BENJAMIN FRANKLIN HWY WEST
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518
Practice Address - Country:US
Practice Address - Phone:610-385-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist