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General NPI Number Information
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NPI Number | 1790118354
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Entity Type | Individual
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Provider Name | JESSICA LEIGH KUIVINEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2013
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Last Update Date | 09/02/2013
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Provider Practice Location Address
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Address Line | 1017 SHELBY RD
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2739
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Country | US
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Telephone | 704-739-2571
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 S DEKALB ST APT 511
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City | SHELBY
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State | NC
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Zip | 28152-8768
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Country | US
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Telephone | 814-673-9820
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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 | 23699
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License Number State | NC
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