MEDICARE: JUNG SU YI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	35639	TX

General Provider Information

NPI Number	:	1114182599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG SU YI RPH

Provider Business Mailing Address
First Line	:	1521 GENEVA LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 GENEVA LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-6837
Country	:	US
Telephone Number	:	972-422-3080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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Directions to “ JUNG SU YI RPH” Practice Location

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