Provider Demographics
NPI:1932784378
Name:KIM, MINYOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINYOUNG
Middle Name:
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 1:1650 S FOX RUN PKWY APT 824
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6136
Mailing Address - Country:US
Mailing Address - Phone:716-262-5858
Mailing Address - Fax:
Practice Address - Street 1:2515 CRAWFORD RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3629
Practice Address - Country:US
Practice Address - Phone:334-297-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist