Provider Demographics
NPI:1083799886
Name:BANG, GRACE SEUNGHAI (RPH)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SEUNGHAI
Last Name:BANG
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 1:3 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5327
Mailing Address - Country:US
Mailing Address - Phone:845-223-6310
Mailing Address - Fax:
Practice Address - Street 1:100 ROUTE 9D
Practice Address - Street 2:CASTLE POINT RD
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:845-838-5189
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist