Provider Demographics
NPI:1578952263
Name:KIM, ANDREW KWANHEE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:KWANHEE
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 SONNETT CT
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1304
Mailing Address - Country:US
Mailing Address - Phone:301-917-5808
Mailing Address - Fax:
Practice Address - Street 1:11520 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2750
Practice Address - Country:US
Practice Address - Phone:301-881-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist