Provider Demographics
NPI:1326321779
Name:KIM, HANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HAN
Other - Middle Name:A
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:866-948-9926
Mailing Address - Fax:
Practice Address - Street 1:532 BROADHOLLOW RD
Practice Address - Street 2:SUITE 137
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3672
Practice Address - Country:US
Practice Address - Phone:866-948-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055466183500000X
NJ28RI03354600183500000X
CTPCT0011431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist