Healthcare Provider Details

I. General information

NPI: 1639938046
Provider Name (Legal Business Name): KIARA KHONG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCHOFIELD AVE
DUDLEY MA
01571-3328
US

IV. Provider business mailing address

220 LOVELL ST
WORCESTER MA
01603-3218
US

V. Phone/Fax

Practice location:
  • Phone: 508-949-0513
  • Fax: 508-943-9527
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH997111
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: