Provider Demographics
NPI:1487068417
Name:VIEIRA, KIRSTEN (RPH)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:VIEIRA
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 1:19594 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2069
Mailing Address - Country:US
Mailing Address - Phone:301-349-9805
Mailing Address - Fax:301-349-4389
Practice Address - Street 1:19594 FISHER AVE
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2069
Practice Address - Country:US
Practice Address - Phone:301-349-9805
Practice Address - Fax:301-349-4389
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist