Provider Demographics
NPI:1114076957
Name:BAE, MI SOOK (PHARM D)
Entity Type:Individual
Prefix:
First Name:MI
Middle Name:SOOK
Last Name:BAE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29533 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5869
Mailing Address - Country:US
Mailing Address - Phone:619-939-6717
Mailing Address - Fax:
Practice Address - Street 1:UNIT 15245 BLDG 3031
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96279-9627
Practice Address - Country:US
Practice Address - Phone:031-573-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist