Provider Demographics
NPI:1902282312
Name:KIM, JULIE J
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HUFFINES BLVD
Mailing Address - Street 2:APT. 3126
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6446
Mailing Address - Country:US
Mailing Address - Phone:512-663-9187
Mailing Address - Fax:
Practice Address - Street 1:3620 HUFFINES BLVD
Practice Address - Street 2:APT. 3126
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6446
Practice Address - Country:US
Practice Address - Phone:512-663-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist