Provider Demographics
NPI:1225360456
Name:HWANG, SOONBONG (RPH)
Entity Type:Individual
Prefix:
First Name:SOONBONG
Middle Name:
Last Name:HWANG
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 1:51 DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2158
Mailing Address - Country:US
Mailing Address - Phone:516-801-3419
Mailing Address - Fax:
Practice Address - Street 1:13698 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:718-461-5500
Practice Address - Fax:718-461-5501
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist