MEDICARE: THOMAS KIM

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	28RI03761900	NJ

General Provider Information

NPI Number	:	1871213504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS KIM

Provider Business Mailing Address
First Line	:	251 MAIN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5778
Country	:	US
Telephone Number	:	201-947-5550
Fax Number	:	201-947-0514

Provider Business Practice Location Address
First Line	:	251 MAIN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5709
Country	:	US
Telephone Number	:	201-947-5550
Fax Number	:	201-947-0514

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

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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Directions to “ THOMAS KIM ” Practice Location

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