Provider Demographics
NPI:1134466949
Name:KIM, DONALD O
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:O
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 SE 165TH MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5861
Mailing Address - Country:US
Mailing Address - Phone:352-751-0304
Mailing Address - Fax:352-751-0305
Practice Address - Street 1:8780 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-751-0304
Practice Address - Fax:352-751-0305
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist