Provider Demographics
NPI:1790991834
Name:SUH, GINA S (PHARMD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:S
Last Name:SUH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:S
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:240 3RD ST
Mailing Address - Street 2:APT #422
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4376
Mailing Address - Country:US
Mailing Address - Phone:714-457-3881
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:ROOM G949 - OUTPATIENT PHARMACY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51291244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist