Healthcare Provider Details

I. General information

NPI: 1295328771
Provider Name (Legal Business Name): SUSIE KIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E NORTHWEST HWY
ARLINGTON HEIGHTS IL
60004-6233
US

IV. Provider business mailing address

929 WATERFORD LN
ELK GROVE VILLAGE IL
60007-7236
US

V. Phone/Fax

Practice location:
  • Phone: 847-253-5494
  • Fax: 847-253-5508
Mailing address:
  • Phone: 224-456-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051303526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: