Provider Demographics
NPI:1275865933
Name:SO, ADA (RPH)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:SO
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 1:7020 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1272
Mailing Address - Country:US
Mailing Address - Phone:718-318-6285
Mailing Address - Fax:844-411-6852
Practice Address - Street 1:7020 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1272
Practice Address - Country:US
Practice Address - Phone:718-318-6285
Practice Address - Fax:844-411-6852
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist