Provider Demographics
NPI:1427434786
Name:CHO, SANG KYU (PHARMD MPH)
Entity type:Individual
Prefix:
First Name:SANG
Middle Name:KYU
Last Name:CHO
Suffix:
Gender:M
Credentials:PHARMD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4934
Mailing Address - Country:US
Mailing Address - Phone:201-568-9378
Mailing Address - Fax:
Practice Address - Street 1:543 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-568-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060508-1183500000X
NJ28RI03681000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist