Healthcare Provider Details

I. General information

NPI: 1083799886
Provider Name (Legal Business Name): GRACE SEUNGHAI BANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 9D CASTLE POINT RD
CASTLE POINT NY
12511
US

IV. Provider business mailing address

3 ALPINE DR
HOPEWELL JUNCTION NY
12533-5327
US

V. Phone/Fax

Practice location:
  • Phone: 845-831-2000
  • Fax: 845-838-5189
Mailing address:
  • Phone: 845-223-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: