Provider Demographics
NPI:1730466913
Name:KIM, JOHN C (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4705
Mailing Address - Country:US
Mailing Address - Phone:201-333-7250
Mailing Address - Fax:201-200-0525
Practice Address - Street 1:753 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4705
Practice Address - Country:US
Practice Address - Phone:201-333-7250
Practice Address - Fax:201-200-0525
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01823600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist