Provider Demographics
NPI:1043519408
Name:KWON, HYUCK S (RPH)
Entity type:Individual
Prefix:
First Name:HYUCK
Middle Name:S
Last Name:KWON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:715 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1427
Mailing Address - Country:US
Mailing Address - Phone:517-663-8430
Mailing Address - Fax:
Practice Address - Street 1:715 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-1427
Practice Address - Country:US
Practice Address - Phone:517-663-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist