Provider Demographics
NPI:1043646045
Name:NAM, SOO HYUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOO
Middle Name:HYUN
Last Name:NAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1618
Mailing Address - Country:US
Mailing Address - Phone:201-592-2201
Mailing Address - Fax:201-242-0499
Practice Address - Street 1:410 BROAD AVE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1618
Practice Address - Country:US
Practice Address - Phone:201-592-2201
Practice Address - Fax:201-242-0499
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058826183500000X
NJ28RI03580500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist