Provider Demographics
NPI:1740725845
Name:SU, EUGENE (PHARM D)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:SU
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6641
Mailing Address - Country:US
Mailing Address - Phone:971-233-1002
Mailing Address - Fax:
Practice Address - Street 1:10903 SE OAK ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6641
Practice Address - Country:US
Practice Address - Phone:971-233-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist