Provider Demographics
NPI:1679059257
Name:SUON, DARA (PHARM D)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:SUON
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 1:13260 ALTA MESA RD
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8356
Mailing Address - Country:US
Mailing Address - Phone:209-822-6311
Mailing Address - Fax:209-473-7377
Practice Address - Street 1:4555 N PERSHING AVE STE 7
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6739
Practice Address - Country:US
Practice Address - Phone:209-373-9629
Practice Address - Fax:209-473-7377
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist