Provider Demographics
NPI:1043496375
Name:SO, ANNIE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ANNIE
Middle Name:
Last Name:SO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1415
Mailing Address - Country:US
Mailing Address - Phone:212-273-0889
Mailing Address - Fax:212-273-0899
Practice Address - Street 1:625 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1415
Practice Address - Country:US
Practice Address - Phone:212-273-0889
Practice Address - Fax:212-273-0899
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist