Healthcare Provider Details

I. General information

NPI: 1295337509
Provider Name (Legal Business Name): SUJUNG RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 SUGARLOAF PKWY
FREDERICK MD
21704-7909
US

IV. Provider business mailing address

12829 LONGFORD GLEN DR
GERMANTOWN MD
20874-4107
US

V. Phone/Fax

Practice location:
  • Phone: 301-874-1201
  • Fax:
Mailing address:
  • Phone: 716-361-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24443
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: