Provider Demographics
NPI:1154644086
Name:KIM, HEARYUN (RPH)
Entity Type:Individual
Prefix:
First Name:HEARYUN
Middle Name:
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 1:270 EXCHANGE BLVD
Mailing Address - Street 2:APT 125
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2768
Mailing Address - Country:US
Mailing Address - Phone:585-461-3197
Mailing Address - Fax:
Practice Address - Street 1:2580 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4526
Practice Address - Country:US
Practice Address - Phone:585-321-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist