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General NPI Number Information
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NPI Number | 1508475898
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Entity Type | Individual
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Provider Name | DANIEL KIM RPH
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Gender | Male
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 4325 ATLANTA HWY
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City | LOGANVILLE
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State | GA
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Zip | 30052-2341
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Country | US
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Telephone | 770-466-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 4231 TOWNCASTLE LN
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City | BUFORD
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State | GA
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Zip | 30518-5167
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Country | US
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Telephone | 678-308-7311
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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 | RPH032157
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License Number State | GA
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