Provider Demographics
NPI:1669549937
Name:KIM, STELLA S (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 CIDER PRESS PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876
Mailing Address - Country:US
Mailing Address - Phone:301-540-0681
Mailing Address - Fax:
Practice Address - Street 1:19718 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1204
Practice Address - Country:US
Practice Address - Phone:301-916-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist