Provider Demographics
NPI:1962006874
Name:KIM, WANHEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:WANHEE
Middle Name:
Last Name:KIM
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 1:1 ORANGETOWN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2143
Mailing Address - Country:US
Mailing Address - Phone:845-359-6100
Mailing Address - Fax:
Practice Address - Street 1:1 ORANGETOWN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2143
Practice Address - Country:US
Practice Address - Phone:845-359-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03639900183500000X
NYI059644-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist