Healthcare Provider Details

I. General information

NPI: 1023079779
Provider Name (Legal Business Name): SOPHON PENNI NOU-CHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PENNI NOU-CHEN

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N WILLOW AVE
CLOVIS CA
93611-4408
US

IV. Provider business mailing address

2772 E SALEM AVE
FRESNO CA
93720-4969
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-0174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: