Provider Demographics
NPI:1033389044
Name:MACK, SOO-YON R (BS)
Entity Type:Individual
Prefix:MR
First Name:SOO-YON
Middle Name:R
Last Name:MACK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2018
Mailing Address - Country:US
Mailing Address - Phone:718-859-2500
Mailing Address - Fax:718-859-0598
Practice Address - Street 1:1525 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2018
Practice Address - Country:US
Practice Address - Phone:718-859-2500
Practice Address - Fax:718-859-0598
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist