=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134595697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. SOPHIA UN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2015
-----------------------------------------------------
Last Update Date | 08/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5208 W PIUTE AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85308-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-698-5278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12900 W THUNDERBIRD RD
-----------------------------------------------------
City | EL MIRAGE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85335-5945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-583-8725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S021499
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------