Provider Demographics
NPI:1366432262
Name:MAI, KIM T (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:T
Last Name:MAI
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 1:6086 SUMMIT CURV
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4492
Mailing Address - Country:US
Mailing Address - Phone:612-387-0707
Mailing Address - Fax:
Practice Address - Street 1:2848 PATTON RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1100
Practice Address - Country:US
Practice Address - Phone:651-796-5314
Practice Address - Fax:651-796-5382
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117982-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist