Healthcare Provider Details

I. General information

NPI: 1275453664
Provider Name (Legal Business Name): KAYLEN SOO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

9200 DOUBLE R BLVD UNIT 4008
RENO NV
89521-9021
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25230
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: