Provider Demographics
NPI:1710377221
Name:MYUNG, SUJEAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUJEAN
Middle Name:
Last Name:MYUNG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1856
Mailing Address - Country:US
Mailing Address - Phone:516-326-3579
Mailing Address - Fax:
Practice Address - Street 1:1730 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1856
Practice Address - Country:US
Practice Address - Phone:516-326-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061143-I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist