Healthcare Provider Details

I. General information

NPI: 1699014787
Provider Name (Legal Business Name): SU-LIN SUN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE
SILVER SPRING MD
20903-1058
US

IV. Provider business mailing address

5265 TRACTOR LN
FAIRFAX VA
22030-7208
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-0036
  • Fax:
Mailing address:
  • Phone: 703-222-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011823
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH3172
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: