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General NPI Number Information
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NPI Number | 1649378274
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Entity Type | Individual
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Provider Name | SUSAN TAEJA KIM PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 BLACKHORSE HILL RD PHARMACY(119)
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City | COATESVILLE
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State | PA
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Zip | 19320-2040
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Country | US
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Telephone | 610-383-0282
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Fax | 610-383-0269
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Provider Business Mailing Address
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Address Line | 1028 WINDING RIVER LN
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3183
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Country | US
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Telephone | 610-935-3232
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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 | 048612-1
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License Number State | NY
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