Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Kim

Individual provider Pharmacist · NPI 1770264103

Jack Kim is a Pharmacist in Maplewood, Minnesota. Licensed in Hawaii, Minnesota and Wisconsin. Registered with an NPI since 2023.

Licensed in
HI, MN, WI
In the registry since
2023
Specialties on file
3
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Practice location Address checks out

100 County Road B W
Maplewood, MN 55117-1931
Phone: (608) 772-8773
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 126132 (MN)
Pharmacist Taxonomy 183500000X · Licence PH-4988 (HI)
Pharmacist Taxonomy 183500000X · Licence 22263 (WI)

Record details

NPI number1770264103
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 27, 2023
Last updated in NPPESAugust 28, 2024
Certification dateAugust 28, 2024
Mailing address100 County Road B W, Maplewood, MN 55117-1931

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