Provider Demographics
NPI:1356883318
Name:TAN, KIM C (RPH)
Entity type:Individual
Prefix:MR
First Name:KIM
Middle Name:C
Last Name:TAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 STARWOOD VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1146
Mailing Address - Country:US
Mailing Address - Phone:919-434-4629
Mailing Address - Fax:
Practice Address - Street 1:125 BLEACHERY BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-8209
Practice Address - Country:US
Practice Address - Phone:828-298-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist