Provider Demographics
NPI:1891207247
Name:HAN, KIMBERLY LAUREN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAUREN
Last Name:HAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3925
Mailing Address - Country:US
Mailing Address - Phone:732-827-2904
Mailing Address - Fax:
Practice Address - Street 1:1303 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3925
Practice Address - Country:US
Practice Address - Phone:732-827-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R103892100183500000X
NJ28RI03892100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist