Provider Demographics
NPI:1336326420
Name:KIM, SUN-KWA SOO (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SUN-KWA
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2611
Mailing Address - Country:US
Mailing Address - Phone:718-231-7301
Mailing Address - Fax:718-231-7303
Practice Address - Street 1:4234 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2611
Practice Address - Country:US
Practice Address - Phone:718-231-7301
Practice Address - Fax:718-231-7303
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy