Provider Demographics
NPI:1689357550
Name:KIM, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
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 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-309-2560
Practice Address - Street 1:1230 S CHERRYBELL STRA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-1907
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-309-2560
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist