Healthcare Provider Details

I. General information

NPI: 1619492972
Provider Name (Legal Business Name): KEVIN HOI-MAN SO PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9851 W CHARLESTON BLVD
LAS VEGAS NV
89117-7516
US

IV. Provider business mailing address

4840 W DESERT INN RD
LAS VEGAS NV
89102-9125
US

V. Phone/Fax

Practice location:
  • Phone: 702-946-1204
  • Fax: 702-946-1208
Mailing address:
  • Phone: 702-248-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03237084
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20163
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: