MEDICARE: EMILY M SU

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	RP440306	PA

General Provider Information

NPI Number	:	1588810949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY M SU

Provider Business Mailing Address
First Line	:	215 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5325
Country	:	US
Telephone Number	:	215-735-3593
Fax Number	:

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/15/2008

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Directions to “ EMILY M SU ” Practice Location

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