Provider Demographics
NPI:1366804676
Name:KWON, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KWON
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 1:5300 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018
Mailing Address - Country:US
Mailing Address - Phone:610-284-6805
Mailing Address - Fax:610-394-2625
Practice Address - Street 1:5300 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:CLIFTON HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:19018
Practice Address - Country:US
Practice Address - Phone:610-284-6805
Practice Address - Fax:610-394-2625
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist