Provider Demographics
NPI:1447846621
Name:SUNG, MINYOUNG
Entity type:Individual
Prefix:
First Name:MINYOUNG
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2142
Mailing Address - Country:US
Mailing Address - Phone:662-312-6949
Mailing Address - Fax:662-329-0081
Practice Address - Street 1:1214 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2142
Practice Address - Country:US
Practice Address - Phone:662-312-6949
Practice Address - Fax:662-329-0081
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-13998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist