Provider Demographics
NPI:1316129885
Name:SMITH, SUNG-SOOK SUE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUNG-SOOK
Middle Name:SUE
Last Name:SMITH
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 1:2255 N TRIPHAMMER RD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1576
Mailing Address - Country:US
Mailing Address - Phone:607-257-1500
Mailing Address - Fax:607-257-2144
Practice Address - Street 1:2255 N TRIPHAMMER RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1576
Practice Address - Country:US
Practice Address - Phone:607-257-1500
Practice Address - Fax:607-257-2144
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist