Provider Demographics
NPI:1417568056
Name:KIM, CHLOE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:M
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 BURKE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3717
Mailing Address - Country:US
Mailing Address - Phone:703-425-0362
Mailing Address - Fax:703-239-1560
Practice Address - Street 1:6011 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3717
Practice Address - Country:US
Practice Address - Phone:703-425-0362
Practice Address - Fax:703-239-1560
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist