Healthcare Provider Details

I. General information

NPI: 1366231482
Provider Name (Legal Business Name): KIM PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 MILWAUKEE AVE UNIT GH
NORTHBROOK IL
60062-7104
US

IV. Provider business mailing address

10570 WING POINTE DR
HUNTLEY IL
60142-6603
US

V. Phone/Fax

Practice location:
  • Phone: 224-649-8500
  • Fax: 224-242-8093
Mailing address:
  • Phone: 224-649-8500
  • Fax: 224-242-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS KIM
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 224-649-8500