Provider Demographics
NPI:1528426657
Name:SUJU ENTERPRISE INC.
Entity type:Organization
Organization Name:SUJU ENTERPRISE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JA YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KONGKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-828-7576
Mailing Address - Street 1:3585 PEACHTREE INDUSTRIAL BLVD STE 158
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6370
Mailing Address - Country:US
Mailing Address - Phone:770-828-7576
Mailing Address - Fax:678-878-2446
Practice Address - Street 1:3585 PEACHTREE INDUSTRIAL BLVD STE 158
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6370
Practice Address - Country:US
Practice Address - Phone:770-828-7576
Practice Address - Fax:678-878-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0102623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157893OtherPK