Provider Demographics
NPI:1083101505
Name:SEOUL PHARMACY INC
Entity Type:Organization
Organization Name:SEOUL PHARMACY INC
Other - Org Name:SEOUL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:HYUN CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-264-9511
Mailing Address - Street 1:14903 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4342
Mailing Address - Country:US
Mailing Address - Phone:718-888-0101
Mailing Address - Fax:718-358-0070
Practice Address - Street 1:14903 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4342
Practice Address - Country:US
Practice Address - Phone:718-888-0101
Practice Address - Fax:718-358-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0366373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7696750001OtherPTAN
2177558OtherPK