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1558026369 NPI number — KOPONG T LIMSON PHARMD

NPI Number: 1558026369
Health Care Provider/Practitioner: KOPONG T LIMSON PHARMD

Information about “1558026369” NPI (KOPONG T LIMSON PHARMD) exists in 1558026369 in HTML format HTML  |  1558026369 in plain Text format TXT  |  1558026369 in PDF (Portable Document Format) PDF  |  1558026369 in an XML format XML  formats.

NPI Number : 1558026369 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558026369",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIMSON",
    "FirstName": "KOPONG",
    "MiddleName": "T",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LIMPICHAREON",
    "OtherFirstName": "KOPONG",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6501 SW MALLET RD APT 304",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENTONVILLE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72713-8219",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-988-8019",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4206 W NEW HOPE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROGERS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72758-8258",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-621-0958",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/05/2021",
    "LastUpdateDate": "11/05/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PD12004",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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