Provider Demographics
NPI:1710436258
Name:KIM, MIN SOO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MIN SOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 W 27TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2344
Mailing Address - Country:US
Mailing Address - Phone:917-628-9633
Mailing Address - Fax:
Practice Address - Street 1:5600 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2300
Practice Address - Country:US
Practice Address - Phone:907-339-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist