MEDICARE: KIM VU 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH031169	GA

General Provider Information

NPI Number	:	1316681679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM VU PHARMD

Provider Business Mailing Address
First Line	:	2177 MURRY TRL
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-1389
Country	:	US
Telephone Number	:	678-670-7034
Fax Number	:

Provider Business Practice Location Address
First Line	:	5664 JONESBORO RD
Second Line	:
City	:	LAKE CITY
State	:	GA
Zip	:	30260-3808
Country	:	US
Telephone Number	:	678-670-7034
Fax Number	:

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

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/22/2022

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Directions to “ KIM VU PHARMD” Practice Location

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