Basic Information
| Provider Information | |||||||||
| NPI: | 1811127509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JEANE | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N. ELM STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327885 | ||||||||
| FaxNumber: | 3368328641 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N. ELM STREET, GROUND FLOOR | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327885 | ||||||||
| FaxNumber: | 3368328641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 12/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 0070-00420 | NC | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P1200X | PS43641 | FL | N | Pharmacy Service Providers | Pharmacist | Pharmacotherapy | 183500000X | 23177 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.