Provider Demographics
NPI:1700288305
Name:KIM, LISA YOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:YOUNG
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 1:2100 VALENCIA DR APT 305
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7088
Mailing Address - Country:US
Mailing Address - Phone:217-721-3991
Mailing Address - Fax:
Practice Address - Street 1:2100 VALENCIA DR APT 305
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7088
Practice Address - Country:US
Practice Address - Phone:217-721-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist