Healthcare Provider Details

I. General information

NPI: 1285399501
Provider Name (Legal Business Name): KEVIN ADAM HSIEH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8015
US

IV. Provider business mailing address

450 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8015
US

V. Phone/Fax

Practice location:
  • Phone: 770-224-1000
  • Fax:
Mailing address:
  • Phone: 770-224-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032156
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: