Provider Demographics
NPI:1285225854
Name:KIM, JOCELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CALLE MEJIA APT 908
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1467
Mailing Address - Country:US
Mailing Address - Phone:541-698-6585
Mailing Address - Fax:
Practice Address - Street 1:7103 4TH ST NW STE G
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6675
Practice Address - Country:US
Practice Address - Phone:505-358-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP008489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist