MEDICARE: MR. SUN-KWA SOO KIM PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	034142	NY

General Provider Information

NPI Number	:	1336326420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUN-KWA SOO KIM PHARMACIST

Provider Business Mailing Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2611
Country	:	US
Telephone Number	:	718-231-7301
Fax Number	:	718-231-7303

Provider Business Practice Location Address
First Line	:	4234 BRONX BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2611
Country	:	US
Telephone Number	:	718-231-7301
Fax Number	:	718-231-7303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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