Provider Demographics
NPI:1699326942
Name:KWAK, HARRY HYUN
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:HYUN
Last Name:KWAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALEXIS DR
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1927
Mailing Address - Country:US
Mailing Address - Phone:267-401-8822
Mailing Address - Fax:
Practice Address - Street 1:1900 ARCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1500
Practice Address - Country:US
Practice Address - Phone:215-587-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI013386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist