Provider Demographics
NPI:1720314685
Name:SEN, SOUM (RPH)
Entity Type:Individual
Prefix:
First Name:SOUM
Middle Name:
Last Name:SEN
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 1:305 W US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2505
Mailing Address - Country:US
Mailing Address - Phone:336-249-0121
Mailing Address - Fax:336-249-6392
Practice Address - Street 1:305 W US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295
Practice Address - Country:US
Practice Address - Phone:336-249-0121
Practice Address - Fax:336-249-6392
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0295717Medicaid