Provider Demographics
NPI:1174065361
Name:CHUNG, JOSHUA JED
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JED
Last Name:CHUNG
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 1:2505 ARUNDEL RD
Mailing Address - Street 2:APT 2
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-2211
Mailing Address - Country:US
Mailing Address - Phone:502-905-9752
Mailing Address - Fax:
Practice Address - Street 1:2505 ARUNDEL RD
Practice Address - Street 2:APT 2
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-2211
Practice Address - Country:US
Practice Address - Phone:502-905-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist