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General NPI Number Information
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NPI Number | 1679079552
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Entity Type | Individual
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Provider Name | MONTHA MICHELLE KIM
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Gender | Female
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Dates
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Enumeration Date | 04/01/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 7101 NE 137TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682
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Country | US
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Telephone | 360-944-4990
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 NE 137TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-4933
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Country | US
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Telephone | 360-944-4980
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PH00049823
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00049823
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License Number State | WA
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