Provider Demographics
NPI:1144561739
Name:KIM-ROMO, DAWN NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:NICOLE
Last Name:KIM-ROMO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:NICOLE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4825 DAVIS LN
Mailing Address - Street 2:APARTMENT 434
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4540
Mailing Address - Country:US
Mailing Address - Phone:512-784-2474
Mailing Address - Fax:
Practice Address - Street 1:200 WEST HOPKINS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:512-396-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist