Provider Demographics
NPI:1679842652
Name:KIM, PHILIP (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 SE ABSHIER BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3807
Mailing Address - Country:US
Mailing Address - Phone:352-245-0177
Mailing Address - Fax:
Practice Address - Street 1:4920 SE ABSHIER BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3807
Practice Address - Country:US
Practice Address - Phone:352-245-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist