Provider Demographics
NPI:1467814657
Name:KIM, MINJU
Entity Type:Individual
Prefix:
First Name:MINJU
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MINJU
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:690 MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3756
Mailing Address - Country:US
Mailing Address - Phone:973-895-2694
Mailing Address - Fax:
Practice Address - Street 1:690 MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3756
Practice Address - Country:US
Practice Address - Phone:973-895-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03011900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist