Provider Demographics
NPI:1063011484
Name:SUM, TAK SHING (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAK SHING
Middle Name:
Last Name:SUM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 N FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3490
Mailing Address - Country:US
Mailing Address - Phone:651-438-3030
Mailing Address - Fax:651-438-1100
Practice Address - Street 1:1752 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3490
Practice Address - Country:US
Practice Address - Phone:651-438-3030
Practice Address - Fax:651-438-1100
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist