Provider Demographics
NPI:1467732107
Name:KIM, SAMANTHA YOO MEE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:YOO MEE
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 1:600 VILLA ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-6720
Mailing Address - Country:US
Mailing Address - Phone:847-695-7727
Mailing Address - Fax:847-695-7548
Practice Address - Street 1:600 VILLA ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-6720
Practice Address - Country:US
Practice Address - Phone:847-695-7727
Practice Address - Fax:847-695-7548
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361924025442Medicaid