Provider Demographics
NPI:1407165459
Name:SUN, TINA (RPH(PHARMACIST))
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:RPH(PHARMACIST)
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1560 HWY 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3521
Mailing Address - Country:US
Mailing Address - Phone:732-493-1212
Mailing Address - Fax:732-695-1419
Practice Address - Street 1:1560 HWY 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3521
Practice Address - Country:US
Practice Address - Phone:732-493-1212
Practice Address - Fax:732-695-1419
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02266900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist