Provider Demographics
NPI:1437567120
Name:KIM, AHNRA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:AHNRA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-2800
Mailing Address - Country:US
Mailing Address - Phone:360-723-9007
Mailing Address - Fax:360-687-8192
Practice Address - Street 1:430 SE 192ND AVE
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9531
Practice Address - Country:US
Practice Address - Phone:360-256-6361
Practice Address - Fax:360-256-6378
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00126951835P0018X
WAPH00067873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist