Provider Demographics
NPI:1477734119
Name:CHONG, SOYUN C (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SOYUN
Middle Name:C
Last Name:CHONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:SOYUN
Other - Middle Name:C
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1831 B GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-466-1000
Mailing Address - Fax:718-466-1006
Practice Address - Street 1:1831 B GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-466-1000
Practice Address - Fax:718-466-1006
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist