Active NPI
Su Kim, PHARMD
- Pharmacist
- Tucker, GA
National Provider Identifier
1982252151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH031562
- Practice address
- 4422 Hugh Howell Rd
Tucker, GA 30084-4915 - Phone
- (770) 621-3180
- NPI assigned
- Aug 29, 2019
- Sex
- Female
- 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 | RPH031562 | GA | Primary |
Addresses
Primary practice location
4422 Hugh Howell Rd
Tucker, GA 30084-4915
Mailing address
4422 Hugh Howell Rd
Tucker, GA 30084-4915
Phone (770) 621-3180
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH031562 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Georgia CVS Pharmacy L.L.C | Past | Accepting new patients |
Organizations & group practices 2
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.
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-
- Pharmacy
- Atlanta, GA
- NPI 1184728016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1982252151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4422 HUGH HOWELL RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844915",
"telephone_number": "770-621-3180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4422 HUGH HOWELL RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844915",
"telephone_number": "770-621-3180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SU",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-29",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH031562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.