Provider Demographics
NPI:1780903286
Name:SUNG SOHN
Entity type:Organization
Organization Name:SUNG SOHN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-624-8580
Mailing Address - Street 1:1 N INDIAN HILL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4769
Mailing Address - Country:US
Mailing Address - Phone:909-624-8580
Mailing Address - Fax:909-624-8615
Practice Address - Street 1:1 N INDIAN HILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4769
Practice Address - Country:US
Practice Address - Phone:909-624-8580
Practice Address - Fax:909-624-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY489213336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5637941OtherNCPDP PROVIDER IDENTIFICATION NUMBER