MEDICARE: SEOK YEONG KIM PHARM.D

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	183500000X	Pharmacist	20104-40	WI

General Provider Information

NPI Number	:	1598390882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEOK YEONG KIM PHARM.D

Provider Business Mailing Address
First Line	:	433 BROADWAY ST S
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1822
Country	:	US
Telephone Number	:	715-235-5349
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 BROADWAY ST S
Second Line	:
City	:	MENOMONIE
State	:	WI
Zip	:	54751-1822
Country	:	US
Telephone Number	:	608-443-9595
Fax Number	:

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

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	03/06/2020

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Directions to “ SEOK YEONG KIM PHARM.D” Practice Location

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