Healthcare Provider Details

I. General information

NPI: 1902418460
Provider Name (Legal Business Name): SUJI MOON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 NE 28TH ST
LINCOLN CITY OR
97367-4518
US

IV. Provider business mailing address

2427 NE HOLMES RD
LINCOLN CITY OR
97367-4925
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-3661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0020742
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: