Individual
YOUNGTAE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD, MBA
Contact information
Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(503) 519-4302
Mailing address
187 NW MARIA ST UNIT 1, COLLEGE PLACE, WA 99324-2152
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
PH60781611
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH60781611
PHAMACIST LICENSE
WA
Enumeration date
01/23/2018
Last updated
01/23/2018
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