Provider Demographics
NPI:1154606416
Name:JUNG, JUDY (RPH)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:JUNG
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 1:4830 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2618
Mailing Address - Country:US
Mailing Address - Phone:874-766-2258
Mailing Address - Fax:847-662-5802
Practice Address - Street 1:4830 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2618
Practice Address - Country:US
Practice Address - Phone:874-766-2258
Practice Address - Fax:847-662-5802
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist