Provider Demographics
NPI:1083189906
Name:CHEN, SOFI (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOFI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12149 DICKENSON LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7649
Mailing Address - Country:US
Mailing Address - Phone:239-860-7345
Mailing Address - Fax:
Practice Address - Street 1:2615 BURNSED BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2705
Practice Address - Country:US
Practice Address - Phone:352-643-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist