Provider Demographics
NPI:1508140930
Name:MEN, SOPHONE R
Entity Type:Individual
Prefix:
First Name:SOPHONE
Middle Name:R
Last Name:MEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-4153
Mailing Address - Country:US
Mailing Address - Phone:323-357-3925
Mailing Address - Fax:323-357-3929
Practice Address - Street 1:9830 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4153
Practice Address - Country:US
Practice Address - Phone:132-335-7392
Practice Address - Fax:132-335-7392
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist