Provider Demographics
NPI:1508959248
Name:KIM, MELISSA YON (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:YON
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:PO BOX 390305
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739
Mailing Address - Country:US
Mailing Address - Phone:808-323-8235
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DRIVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96739
Practice Address - Country:US
Practice Address - Phone:808-322-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist