Provider Demographics
NPI:1962834929
Name:KIM, TOMEKA PARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:TOMEKA
Middle Name:PARK
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 1:495 RUBY FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3928
Mailing Address - Country:US
Mailing Address - Phone:843-452-7307
Mailing Address - Fax:
Practice Address - Street 1:495 RUBY FOREST PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3928
Practice Address - Country:US
Practice Address - Phone:843-452-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist