Healthcare Provider Details

I. General information

NPI: 1851690366
Provider Name (Legal Business Name): KIMBERLY BONDA SAYASENG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 RALEIGH RD
ROCKY MOUNT NC
27803-2622
US

IV. Provider business mailing address

3612 KEMBLE RIDGE DR
WAKE FOREST NC
27587-4865
US

V. Phone/Fax

Practice location:
  • Phone: 252-446-0391
  • Fax: 252-985-2350
Mailing address:
  • Phone: 919-556-8974
  • Fax: 252-985-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: