Provider Demographics
NPI:1730608647
Name:KIM, JENNIFER YUN (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YUN
Last Name:KIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8601
Mailing Address - Country:US
Mailing Address - Phone:877-627-6337
Mailing Address - Fax:877-828-3939
Practice Address - Street 1:2354 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8601
Practice Address - Country:US
Practice Address - Phone:877-627-6337
Practice Address - Fax:877-828-3939
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46976OtherSTATE BOARD
FLPS46976OtherBOARD OF PHARMACY