MEDICARE: SUNG HAE SON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI04334900	NJ

General Provider Information

NPI Number	:	1164204186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNG HAE SON PHARMD

Provider Business Mailing Address
First Line	:	301 RIVERFRONT BLVD APT 403
Second Line	:
City	:	ELMWOOD PARK
State	:	NJ
Zip	:	07407-1041
Country	:	US
Telephone Number	:	732-543-5772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2468 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6206
Country	:	US
Telephone Number	:	201-944-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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