Provider Demographics
NPI:1255624003
Name:AN, SANG WOO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:WOO
Last Name:AN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:WOO
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:323 S WALKER ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2756
Mailing Address - Country:US
Mailing Address - Phone:304-431-4967
Mailing Address - Fax:304-431-5405
Practice Address - Street 1:323 S WALKER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2756
Practice Address - Country:US
Practice Address - Phone:304-431-4967
Practice Address - Fax:304-431-5405
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007558183500000X
MD20083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist