Provider Demographics
NPI:1346396025
Name:KORT, KIM R (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:R
Last Name:KORT
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 1:12 GOOD DAY CT
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-7700
Mailing Address - Country:US
Mailing Address - Phone:828-278-2088
Mailing Address - Fax:
Practice Address - Street 1:123 PARK ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-4319
Practice Address - Country:US
Practice Address - Phone:828-235-9196
Practice Address - Fax:828-235-9196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist