Provider Demographics
NPI:1639761125
Name:KIMA, CLARA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:KIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 LONDONDERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5621
Mailing Address - Country:US
Mailing Address - Phone:571-451-3153
Mailing Address - Fax:
Practice Address - Street 1:6301 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2636
Practice Address - Country:US
Practice Address - Phone:571-451-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist