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General NPI Number Information
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NPI Number | 1558673707
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Entity Type | Individual
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Provider Name | KIM G CONNER R.PH. M.AC
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Gender | Male
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Dates
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Enumeration Date | 07/04/2010
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Last Update Date | 07/04/2010
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Provider Practice Location Address
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Address Line | 4834 WATER PARK DR
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City | BELCAMP
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State | MD
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Zip | 21017-1442
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Country | US
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Telephone | 443-838-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 YELLOWWOOD AVE
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City | BALTIMORE
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State | MD
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Zip | 21209-4622
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Country | US
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Telephone | 410-592-2752
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Fax | 443-327-6547
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U00671
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1835N1003X
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Taxonomy Name | Nutrition Support Pharmacist
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License Number | 12008
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License Number State | MD
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Taxonomy #3
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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 | 12008
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License Number State | MD
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