Provider Demographics
NPI:1063880151
Name:JEONG, DA HAE (PHARMD)
Entity type:Individual
Prefix:
First Name:DA HAE
Middle Name:
Last Name:JEONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 KEY ST
Mailing Address - Street 2:APT. 3Q
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4872
Mailing Address - Country:US
Mailing Address - Phone:419-215-8975
Mailing Address - Fax:
Practice Address - Street 1:6725 W CENTRAL AVE
Practice Address - Street 2:SUITE N
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1148
Practice Address - Country:US
Practice Address - Phone:419-841-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03335049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist