Healthcare Provider Details

I. General information

NPI: 1164113056
Provider Name (Legal Business Name): TING SOMSY PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TING KEOVILAI PHARMACY TECHNICIAN

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 W SHAW AVE
FRESNO CA
93711-3404
US

IV. Provider business mailing address

6690 N IVANHOE AVE
FRESNO CA
93722-3051
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-0920
  • Fax: 559-225-0114
Mailing address:
  • Phone: 559-907-0678
  • Fax: 559-225-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH46100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: