Provider Demographics
NPI:1093005506
Name:SUM, KWOK LEUNG BRYAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KWOK LEUNG BRYAN
Middle Name:
Last Name:SUM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:SUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:4721 DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-447-9570
Mailing Address - Fax:502-447-1184
Practice Address - Street 1:4721 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2654
Practice Address - Country:US
Practice Address - Phone:502-447-9570
Practice Address - Fax:502-447-1184
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist