Provider Demographics
NPI:1750771929
Name:DONG SEO PHARMACY LLC
Entity type:Organization
Organization Name:DONG SEO PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-614-7000
Mailing Address - Street 1:3622A UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4115
Mailing Address - Country:US
Mailing Address - Phone:718-888-7811
Mailing Address - Fax:718-888-0025
Practice Address - Street 1:142-20 38AVE
Practice Address - Street 2:SUITE CF-D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4115
Practice Address - Country:US
Practice Address - Phone:718-888-7811
Practice Address - Fax:718-888-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04173731Medicaid
NY04173731Medicaid