Individual
JACK KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 COUNTY ROAD B W, MAPLEWOOD, MN 55117-1931
(608) 772-8773
Mailing address
100 COUNTY ROAD B W, MAPLEWOOD, MN 55117-1931
(608) 772-8773
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
126132
MN
183500000X
Pharmacist
22263
WI
183500000X
Pharmacist
PH-4988
HI
Other
Enumeration date
07/27/2023
Last updated
08/28/2024
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