MEDICARE: ERIC T SUEN

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	1-14046	KS

General Provider Information

NPI Number	:	1497350615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC T SUEN

Provider Business Mailing Address
First Line	:	4645 SHAWNEE DR
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-3648
Country	:	US
Telephone Number	:	913-236-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 SHAWNEE DR
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66106-3648
Country	:	US
Telephone Number	:	913-236-4000
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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