Provider Demographics
NPI:1346609278
Name:KIM, KWANG-SIK (RPH)
Entity Type:Individual
Prefix:
First Name:KWANG-SIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 WELSH RD
Mailing Address - Street 2:C-1
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2054
Mailing Address - Country:US
Mailing Address - Phone:215-393-0902
Mailing Address - Fax:215-393-0904
Practice Address - Street 1:1222 WELSH RD
Practice Address - Street 2:C-1
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2054
Practice Address - Country:US
Practice Address - Phone:215-393-0902
Practice Address - Fax:215-393-0904
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043232L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP043232LOtherSTATE LICENSE