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NPI Code Detail

MEDICARE: JENNIFER KIM PHARM.D

MEDICARE: JENNIFER KIM PHARM.D
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
1183500000XPharmacist051297365IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13777095OTHERILUNITED HEALTH CARE

General Provider Information

NPI Number : 1306268883
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KIM PHARM.D
Provider Business Mailing Address
First Line : 200 WILMONT RD
Second Line :
City : DEERFIELD
State : IL
Zip : 60015
Country : US
Telephone Number : 847-940-2500
Fax Number :
Provider Business Practice Location Address
First Line : 3232 LAKE AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1073
Country : US
Telephone Number : 847-251-1413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 01/17/2014

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