MEDICARE: ISAAC GUMDUK KIM PHARMD

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	21703	MD

General Provider Information

NPI Number	:	1205277324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC GUMDUK KIM PHARMD

Provider Business Mailing Address
First Line	:	6125 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	646-725-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	646-725-8318
Fax Number	:

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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