Provider Demographics
NPI:1235914524
Name:VONN, SOMALYN
Entity Type:Individual
Prefix:
First Name:SOMALYN
Middle Name:
Last Name:VONN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 FORT EVANS RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4097
Mailing Address - Country:US
Mailing Address - Phone:571-209-5631
Mailing Address - Fax:571-209-5637
Practice Address - Street 1:526 FORT EVANS RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4097
Practice Address - Country:US
Practice Address - Phone:571-209-5631
Practice Address - Fax:571-209-5637
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202221517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist