Healthcare Provider Details

I. General information

NPI: 1447973847
Provider Name (Legal Business Name): SANGRYUN MI RYU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 US-6
MAHOPAC NY
10541
US

IV. Provider business mailing address

31 SCENIC DR APT B
CROTON ON HUDSON NY
10520-1807
US

V. Phone/Fax

Practice location:
  • Phone: 845-628-5299
  • Fax:
Mailing address:
  • Phone: 929-331-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: