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General NPI Number Information
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NPI Number | 1841755949
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Entity Type | Individual
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Provider Name | KIM SISOUK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 3480 S JEFFERSON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22041-3104
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Country | US
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Telephone | 703-931-1333
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Fax | 844-411-6528
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Provider Business Mailing Address
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Address Line | 6710 PORTREE CT
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City | SPRINGFIELD
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State | VA
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Zip | 22152-2933
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Country | US
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Telephone | 707-217-6997
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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 | PH100002630
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24641
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202215342
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License Number State | VA
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