MEDICARE: KRISTINA 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	22482	NV

General Provider Information

NPI Number	:	1144159476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KIM

Provider Business Mailing Address
First Line	:	11010 ONSLOW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2228
Country	:	US
Telephone Number	:	224-735-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 S MAIN ST
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-2211
Country	:	US
Telephone Number	:	434-392-3104
Fax Number	:

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ KRISTINA KIM ” Practice Location

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