Provider Demographics
NPI:1124789425
Name:SOHN, MYRA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:
Last Name:SOHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4722
Mailing Address - Country:US
Mailing Address - Phone:909-624-8580
Mailing Address - Fax:909-752-7464
Practice Address - Street 1:130 YALE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4722
Practice Address - Country:US
Practice Address - Phone:909-624-8580
Practice Address - Fax:909-752-7464
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty