Provider Demographics
NPI:1184621492
Name:MYONG, ALICE S (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:S
Last Name:MYONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EMBARCADERO
Mailing Address - Street 2:STE 400
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5334
Mailing Address - Country:US
Mailing Address - Phone:510-383-1737
Mailing Address - Fax:
Practice Address - Street 1:2000 EMBARCADERO
Practice Address - Street 2:STE 400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5334
Practice Address - Country:US
Practice Address - Phone:510-383-1737
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 529741835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric