Provider Demographics
NPI:1508048034
Name:SUNG-MONAHAN, JULIA (RPH)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SUNG-MONAHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5004
Mailing Address - Country:US
Mailing Address - Phone:631-724-0381
Mailing Address - Fax:631-366-3789
Practice Address - Street 1:10 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2615
Practice Address - Country:US
Practice Address - Phone:631-724-0381
Practice Address - Fax:631-366-2688
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00275512Medicaid