Provider Demographics
NPI:1912382896
Name:KIM, JUNG GEUM (RPH60115016)
Entity Type:Individual
Prefix:
First Name:JUNG GEUM
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RPH60115016
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1153
Mailing Address - Country:US
Mailing Address - Phone:509-865-4700
Mailing Address - Fax:
Practice Address - Street 1:711 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1153
Practice Address - Country:US
Practice Address - Phone:509-865-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60115016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist