1295935450 NPI number — DR. ELISA JIHYUN CHOI PHARM D

Table of content: DR. ELISA JIHYUN CHOI PHARM D (NPI 1295935450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295935450 NPI number — DR. ELISA JIHYUN CHOI PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOI
Provider First Name:
ELISA
Provider Middle Name:
JIHYUN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295935450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1326 WEYMOUTH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28270-9770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-877-9642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7323 E INDEPENDENCE BLVD
Provider Second Line Business Practice Location Address:
UNIT F4-F5
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28227-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-531-2626
Provider Business Practice Location Address Fax Number:
704-531-2161
Provider Enumeration Date:
07/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17816 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)