Provider Demographics
NPI:1992002943
Name:KIM, DONALD D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
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 1:1768 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1827
Mailing Address - Country:US
Mailing Address - Phone:516-352-8527
Mailing Address - Fax:
Practice Address - Street 1:1768 STEWART AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1827
Practice Address - Country:US
Practice Address - Phone:516-352-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0312521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031252Medicaid