Provider Demographics
NPI:1699967539
Name:KIM, TORY LYNN (RPH PHARMD BCPS)
Entity type:Individual
Prefix:DR
First Name:TORY
Middle Name:LYNN
Last Name:KIM
Suffix:
Gender:F
Credentials:RPH PHARMD BCPS
Other - Prefix:MS
Other - First Name:TORY
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5620 119TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3738
Mailing Address - Country:US
Mailing Address - Phone:425-746-8162
Mailing Address - Fax:
Practice Address - Street 1:5620 119TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3738
Practice Address - Country:US
Practice Address - Phone:425-746-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 198501835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB14818Medicare UPIN