Healthcare Provider Details

I. General information

NPI: 1437567120
Provider Name (Legal Business Name): AHNRA KIM PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ANNA KIM

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SE 192ND AVE WALMART PHARMACY
VANCOUVER WA
98683-9531
US

IV. Provider business mailing address

1201 SW 13TH AVE
BATTLE GROUND WA
98604-2800
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-6361
  • Fax: 360-256-6378
Mailing address:
  • Phone: 360-723-9007
  • Fax: 360-687-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00067873
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0012695
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: