Sungjoon David An, PHARMD – Pharmacist

Key facts

NPI: 1639985484
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: 7071442 (ID)
Practice address: 4657 S Eagle Rd
Meridian, ID 83642-7077
Phone: (208) 272-9730
NPI assigned: Dec 6, 2024
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Albertsons LLC Community/Retail Pharmacy · Ardmore, OK · NPI 1134958457

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Pharmacy

State licenses

License	State	Type	Specialty
7071442	ID	MD	Pharmacist

Practice roles

Organization	Specialty	Status	New patients
Albertsons LLC		Past since Dec 8, 2024	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	7071442	ID	Yes

Addresses

Primary practice location

4657 S Eagle Rd
Meridian, ID 83642-7077

Mailing address

4514 N Girasolo Ave
Meridian, ID 83646-3391
Phone (208) 813-0414

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2024.

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1639985484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4514 N GIRASOLO AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836463391",
            "telephone_number": "208-813-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4657 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427077",
            "telephone_number": "208-272-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AN",
        "first_name": "SUNGJOON",
        "middle_name": "DAVID",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-06",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "7071442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

All providers in Meridian, ID · Pharmacist in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.