Healthcare Provider Details

I. General information

NPI: 1295332542
Provider Name (Legal Business Name): SOMALY KIEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 PINEVILLE MATTHEWS RD
CHARLOTTE NC
28226-9304
US

IV. Provider business mailing address

9026 COUNTRY BARN CT
CHARLOTTE NC
28273-7824
US

V. Phone/Fax

Practice location:
  • Phone: 704-543-6055
  • Fax:
Mailing address:
  • Phone: 336-740-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: