Provider Demographics
NPI:1851690366
Name:SAYASENG, KIMBERLY BONDA (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BONDA
Last Name:SAYASENG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 KEMBLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4865
Mailing Address - Country:US
Mailing Address - Phone:919-556-8974
Mailing Address - Fax:252-985-2350
Practice Address - Street 1:800 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-2622
Practice Address - Country:US
Practice Address - Phone:252-446-0391
Practice Address - Fax:252-985-2350
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist