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General NPI Number Information
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NPI Number | 1336576891
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Entity Type | Individual
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Provider Name | MICHELLE SU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 7559 263RD ST
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City | GLEN OAKS
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State | NY
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Zip | 11004-1150
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Country | US
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Telephone | 718-470-5710
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Fax |
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Provider Business Mailing Address
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Address Line | 7 JEFFREY LN
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City | GREAT NECK
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State | NY
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Zip | 11020-1607
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Country | US
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Telephone | 347-534-7842
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 048518
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License Number State | NY
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