Tae-Woo Kim
Individual provider Active NPI Pharmacist · Green Brook, NJ
NPI 1215763586 · NPPES record last updated Sep 12, 2024
Key facts
- NPI
- 1215763586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28RI04381800 (NJ)
- Practice address
- 247 US Highway 22
Green Brook, NJ 08812-1807 - Phone
- (732) 655-4976
- NPI assigned
- Sep 12, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI04381800 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Locations
247 US Highway 22
Green Brook, NJ 08812
Phone (732) 624-1520
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI04381800 | NJ | Yes |
Addresses
Primary practice location
247 US Highway 22
Green Brook, NJ 08812-1807
Mailing address
247 US Highway 22
Green Brook, NJ 08812-1807
Other providers in Green Brook, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.