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General NPI Number Information
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NPI Number | 1366432262
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Entity Type | Individual
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Provider Name | KIM T MAI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2848 PATTON RD
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City | ROSEVILLE
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State | MN
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Zip | 55113-1100
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Country | US
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Telephone | 651-796-5314
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Fax | 651-796-5382
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Provider Business Mailing Address
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Address Line | 6086 SUMMIT CURV
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4492
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Country | US
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Telephone | 612-387-0707
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 117982-0
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License Number State | MN
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