Individual
BOUNCHANH SOURIYAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
1211 MEDICAL CENTER DR, NASHVILLE, TN 37232-0004
(615) 343-0608
Mailing address
2804 BRIGHTWOOD AVE, NASHVILLE, TN 37212-5821
(615) 585-6642
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
36827
TN
Other
Enumeration date
07/14/2012
Last updated
07/14/2012
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