Healthcare Provider Details

I. General information

NPI: 1124578042
Provider Name (Legal Business Name): VINNIE KEW PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 MARYLAND WAY
BRENTWOOD TN
37027-5064
US

IV. Provider business mailing address

2197 HIGHWAY 40
LEWISBURG TN
37091-6111
US

V. Phone/Fax

Practice location:
  • Phone: 855-212-2273
  • Fax:
Mailing address:
  • Phone: 248-210-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302040565
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: