Provider Demographics
NPI:1376764936
Name:SO, SOKHAK (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOKHAK
Middle Name:
Last Name:SO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4820
Mailing Address - Country:US
Mailing Address - Phone:120-394-7208
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL PLAZA
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-276-6194
Practice Address - Fax:203-276-7308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist