Provider Demographics
NPI:1053638957
Name:KIM, KAREN (BS PHARM)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 BAXTER AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1313
Mailing Address - Country:US
Mailing Address - Phone:718-457-0099
Mailing Address - Fax:
Practice Address - Street 1:8004 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1313
Practice Address - Country:US
Practice Address - Phone:718-457-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist