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General NPI Number Information
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NPI Number | 1447039482
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Entity Type | Individual
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Provider Name | SUNG EUN MO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1500 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3318
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Country | US
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Telephone | 573-686-4151
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Fax |
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Provider Business Mailing Address
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Address Line | 115 KALI LN APT A
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-9008
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Country | US
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Telephone | 334-804-9621
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | P10976
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH034808
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License Number State | GA
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