Provider Demographics
NPI:1124341565
Name:PLASS, KIM M (RPH)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:PLASS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1267
Mailing Address - Country:US
Mailing Address - Phone:518-828-0500
Mailing Address - Fax:518-828-9279
Practice Address - Street 1:160 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1267
Practice Address - Country:US
Practice Address - Phone:518-828-0500
Practice Address - Fax:518-828-9279
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist