Basic Information
Provider Information
NPI: 1386022465
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HONG
FirstName: JOSEPH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5001
Address2: BAY PINES VA
City: BAY PINES
State: FL
PostalCode: 337445001
CountryCode: US
TelephoneNumber: 7273986661
FaxNumber: 7273989506
Practice Location
Address1: 10000 BAY PINES BLVD
Address2: MAIL CODE 119
City: BAY PINES
State: FL
PostalCode: 337448200
CountryCode: US
TelephoneNumber: 7273986661
FaxNumber: 7273989506
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 05/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPS49060FLY Pharmacy Service ProvidersPharmacist 

No ID Information.


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