Provider Demographics
NPI:1497169122
Name:SON, SUZANNA MIRI
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:MIRI
Last Name:SON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNA
Other - Middle Name:
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:336 FALLINGSTAR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7569
Mailing Address - Country:US
Mailing Address - Phone:714-403-0521
Mailing Address - Fax:
Practice Address - Street 1:336 FALLINGSTAR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7569
Practice Address - Country:US
Practice Address - Phone:714-403-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 67323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist