Provider Demographics
NPI:1205422524
Name:KIM, PAUL J (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3301
Mailing Address - Country:US
Mailing Address - Phone:267-297-6482
Mailing Address - Fax:267-297-6423
Practice Address - Street 1:109 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3301
Practice Address - Country:US
Practice Address - Phone:267-297-6482
Practice Address - Fax:267-297-6423
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist