Provider Demographics
NPI:1457440570
Name:SU, MICHAEL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:SU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CAPE COD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620
Mailing Address - Country:US
Mailing Address - Phone:714-279-4381
Mailing Address - Fax:
Practice Address - Street 1:441 NORTH LAKEVIEW AVE.
Practice Address - Street 2:KAISER PERMANANTE MEDICAL CENTER IN-PT PHARMACY
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-279-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist