Active NPI
Keetae Kim
- Pharmacist
- Warner Robins, GA
National Provider Identifier
1043955339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH032854
- Practice address
- 1880 Watson Blvd
Warner Robins, GA 31093-3612 - Phone
- (478) 975-9677
- NPI assigned
- May 1, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH032854 | GA | Primary |
Addresses
Primary practice location
1880 Watson Blvd
Warner Robins, GA 31093-3612
Mailing address
1880 Watson Blvd
Warner Robins, GA 31093-3612
Phone (478) 975-9677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH032854 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652054400000",
"number": "1043955339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1880 WATSON BLVD",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310933612",
"telephone_number": "478-975-9677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 WATSON BLVD",
"city": "WARNER ROBINS",
"state": "GA",
"postal_code": "310933612",
"telephone_number": "478-975-9677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "KEETAE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-01",
"last_updated": "2022-05-09",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH032854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warner Robins, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.