Provider Demographics
NPI:1306123393
Name:RIENGNIMIT, CONNIE SHIEH
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SHIEH
Last Name:RIENGNIMIT
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 1:5515 LEESBURG PIKE
Mailing Address - Street 2:T-1893
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3109
Mailing Address - Country:US
Mailing Address - Phone:703-253-0022
Mailing Address - Fax:703-253-0022
Practice Address - Street 1:5515 LEESBURG PIKE
Practice Address - Street 2:T-1893
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3109
Practice Address - Country:US
Practice Address - Phone:703-253-0022
Practice Address - Fax:703-253-0022
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210241183500000X
DCPH100001029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist