Provider Demographics
NPI:1336937937
Name:KIM, MINSU (PHARMD)
Entity type:Individual
Prefix:
First Name:MINSU
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 GRAPEVINE MILLS PKWY APT 824
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1913
Mailing Address - Country:US
Mailing Address - Phone:502-751-7163
Mailing Address - Fax:
Practice Address - Street 1:1000 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3111
Practice Address - Country:US
Practice Address - Phone:972-304-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist