=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508486747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN YANJUN CHEN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2020
-----------------------------------------------------
Last Update Date | 04/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MANNING DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-4220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 984-974-1706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6205 FARRINGTON RD APT F9
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27517-7851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-266-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 27822
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------