Healthcare Provider Details

I. General information

NPI: 1164204186
Provider Name (Legal Business Name): SUNG HAE SON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINWOOD AVE W
PARAMUS NJ
07652-2355
US

IV. Provider business mailing address

301 RIVERFRONT BLVD APT 403
ELMWOOD PARK NJ
07407-1041
US

V. Phone/Fax

Practice location:
  • Phone: 201-389-0510
  • Fax: 201-389-0224
Mailing address:
  • Phone: 732-543-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04334900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: