Provider Demographics
NPI:1114914041
Name:KORTJE, KIM YVETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:YVETTE
Last Name:KORTJE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CIRCLE DR.
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730
Mailing Address - Country:US
Mailing Address - Phone:402-841-1153
Mailing Address - Fax:
Practice Address - Street 1:2100 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-1705
Practice Address - Country:US
Practice Address - Phone:605-665-8261
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9093183500000X
SDR5392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE9093OtherPHARMACY LICENSE
SDR5392OtherPHARMACY LICENSE