Healthcare Provider Details

I. General information

NPI: 1427231281
Provider Name (Legal Business Name): SEONGCHUL HONG PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E 14TH ST
NEW YORK NY
10009-3336
US

IV. Provider business mailing address

5370 1ST AVE
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-2455
  • Fax:
Mailing address:
  • Phone: 646-703-4132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: