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General NPI Number Information
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NPI Number | 1295328771
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Entity Type | Individual
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Provider Name | SUSIE KIM PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 2323 CAPITAL DR
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City | NORTHBROOK
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State | IL
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Zip | 60062-6144
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Country | US
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Telephone | 847-513-0077
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Fax | 847-513-0052
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Provider Business Mailing Address
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Address Line | 929 WATERFORD LN
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-7236
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Country | US
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Telephone | 224-456-3091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051303526
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License Number State | IL
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