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General NPI Number Information
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NPI Number | 1316543101
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Entity Type | Individual
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Provider Name | CHUONG KIM VAN
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Gender | Female
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 277 W STATE ROAD 436
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-4228
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Country | US
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Telephone | 407-389-6025
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Fax | 407-385-6031
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Provider Business Mailing Address
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Address Line | 7761 ISLEWOOD CT
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City | SANFORD
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State | FL
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Zip | 32771-8113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS40815
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License Number State | FL
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