Healthcare Provider Details

I. General information

NPI: 1114914041
Provider Name (Legal Business Name): KIM YVETTE KORTJE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROADWAY AVE
YANKTON SD
57078-1705
US

IV. Provider business mailing address

5 CIRCLE DR.
CROFTON NE
68730
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-8261
  • Fax:
Mailing address:
  • Phone: 402-841-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9093
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR5392
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: