Provider Demographics
NPI:1679116792
Name:SOU, SODANG DANIEL (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:SODANG
Middle Name:DANIEL
Last Name:SOU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 GLIDING HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-9500
Mailing Address - Country:US
Mailing Address - Phone:904-434-9281
Mailing Address - Fax:
Practice Address - Street 1:901 S HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9397
Practice Address - Country:US
Practice Address - Phone:386-325-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist