=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659686798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MI HUI KIM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2010
-----------------------------------------------------
Last Update Date | 08/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 OUTWATER LN RITE AID PHARMACY
-----------------------------------------------------
City | GARFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07026-3859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-772-2937
-----------------------------------------------------
Fax | 973-772-7086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 PINE TER W
-----------------------------------------------------
City | SHORT HILLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07078-2470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-757-0846
-----------------------------------------------------
Fax | 973-772-7086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RS00342500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH00052419
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------