Provider Demographics
NPI:1679618805
Name:KIM, DEBORAH PARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:PARK
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1683 LONGVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5170
Mailing Address - Country:US
Mailing Address - Phone:847-921-4404
Mailing Address - Fax:
Practice Address - Street 1:200 WILMOT RD
Practice Address - Street 2:MS L444
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4620
Practice Address - Country:US
Practice Address - Phone:847-964-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist