Provider Demographics
NPI:1417320367
Name:OH, TAE SEUNG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAE
Middle Name:SEUNG
Last Name:OH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 AERIE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1103
Mailing Address - Country:US
Mailing Address - Phone:301-256-5656
Mailing Address - Fax:
Practice Address - Street 1:5301 AERIE CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1103
Practice Address - Country:US
Practice Address - Phone:301-256-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist