Provider Demographics
NPI:1104554872
Name:KIM, KENNETH (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1684
Mailing Address - Country:US
Mailing Address - Phone:201-978-4338
Mailing Address - Fax:
Practice Address - Street 1:801 E PHILADELPHIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1321
Practice Address - Country:US
Practice Address - Phone:610-369-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4558583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy