MEDICARE: XENA KAI SENGSOUVANNAPRASEUTH CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	30022575	TX

General Provider Information

NPI Number	:	1124981774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XENA KAI SENGSOUVANNAPRASEUTH CPHT

Provider Business Mailing Address
First Line	:	1207 DELAWARE AVE STE 2330
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4743
Country	:	US
Telephone Number	:	888-738-0073
Fax Number	:	856-677-9199

Provider Business Practice Location Address
First Line	:	1207 DELAWARE AVE STE 2330
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4743
Country	:	US
Telephone Number	:	888-738-0073
Fax Number	:	856-677-9199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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