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General NPI Number Information
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NPI Number | 1073917449
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Entity Type | Organization
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Legal Business Name | SUJU ENTERPRISE INC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 3585 PEACHTREE INDUSTRIAL BLVD STE 158
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City | DULUTH
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State | GA
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Zip | 30096-6370
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Country | US
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Telephone | 727-667-4692
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Fax | 678-878-2446
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Provider Business Mailing Address
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Address Line | 3585 PEACHTREE INDUSTRIAL BLVD STE 158
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City | DULUTH
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State | GA
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Zip | 30096-6370
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Country | US
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Telephone | 727-667-4692
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Fax | 678-878-2446
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Authorized Official
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Title or Position | PRESIDENT
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Name | JA YOUNG KONGKIM
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Credential |
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Telephone | 678-878-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010077
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License Number State | GA
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