Provider Demographics
NPI:1073956520
Name:KIM, STEPHANIE E (RPH)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:E
Last Name:KIM
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 1:3190 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3110
Mailing Address - Country:US
Mailing Address - Phone:303-750-2452
Mailing Address - Fax:303-743-1455
Practice Address - Street 1:3190 S PARKER RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3110
Practice Address - Country:US
Practice Address - Phone:303-750-2452
Practice Address - Fax:303-743-1455
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist