MEDICARE: JENNIFER KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202212245	VA

General Provider Information

NPI Number	:	1063853984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KIM

Provider Business Mailing Address
First Line	:	4048 JENITA DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1197
Country	:	US
Telephone Number	:	727-781-7956
Fax Number	:

Provider Business Practice Location Address
First Line	:	4048 JENITA DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1197
Country	:	US
Telephone Number	:	727-781-7956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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Directions to “ JENNIFER KIM ” Practice Location

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