Provider Demographics
NPI:1750737201
Name:KIM, SOHEE
Entity type:Individual
Prefix:
First Name:SOHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9404 CRESCENT LOOP CIR APT 7305
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7676
Mailing Address - Country:US
Mailing Address - Phone:561-809-0356
Mailing Address - Fax:
Practice Address - Street 1:9404 CRESCENT LOOP CIR APT 7305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7676
Practice Address - Country:US
Practice Address - Phone:561-809-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52937183500000X
TXPS56206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist