Provider Demographics
NPI:1750859666
Name:KIM, EMMANUEL J (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 INNOVATION PARK DR STE 403
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4868
Mailing Address - Country:US
Mailing Address - Phone:571-472-3498
Mailing Address - Fax:
Practice Address - Street 1:8095 INNOVATION PARK DR STE 403
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4868
Practice Address - Country:US
Practice Address - Phone:571-472-3498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202217142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA202217142OtherPHARMACY LICENSE