Healthcare Provider Details

I. General information

NPI: 1790118354
Provider Name (Legal Business Name): JESSICA LEIGH KUIVINEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 SHELBY RD
KINGS MOUNTAIN NC
28086-2739
US

IV. Provider business mailing address

1635 S DEKALB ST APT 511
SHELBY NC
28152-8768
US

V. Phone/Fax

Practice location:
  • Phone: 704-739-2571
  • Fax:
Mailing address:
  • Phone: 814-673-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23699
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: