Provider Demographics
NPI:1346391612
Name:JOE, SUNG H (RPH)
Entity Type:Individual
Prefix:MR
First Name:SUNG
Middle Name:H
Last Name:JOE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LOH AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4631
Mailing Address - Country:US
Mailing Address - Phone:914-631-5711
Mailing Address - Fax:914-631-5711
Practice Address - Street 1:LINCOLN MEDICAL AND MENTAL HEALTH CENTER
Practice Address - Street 2:234 EUGENIO MARIA DE HOSTOS BLVD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist