Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1770264103 Individual Practitioner Male Practitioner

Jack Kim

Pharmacist • Maplewood, MN

Professional Overview & Biography Verified Profile Summary

Jack Kim is a registered healthcare professional specializing in Pharmacist in Maplewood, MN. Practice services are available at 100 COUNTY ROAD B W under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

100 County Road B W

Maplewood, MN 551171931

Telephone 6087728773
Associated Practice Facility / Clinic
🏢 Supervalu Pharmacies Inc Facility NPI 1407961543

Specialty Benchmarks & Practice Insights

Comparative analytics for Pharmacist in Maplewood, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
36 Specialists

Practicing in Maplewood, MN (4994 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-08-28
Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

State License MN 126132

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Pharmacist

NUCC Taxonomy Code: 183500000X

State License HI PH-4988

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Pharmacist

NUCC Taxonomy Code: 183500000X

State License WI 22263

An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
NPI 1124221577

Registered Pharmacist

Tony Yalo

Pharmacist

NPI 1285221895
NPI 1306432356

Doctor of Pharmacy (Pharm.D.)

NPI 1558150896

Doctor of Pharmacy (Pharm.D.)

NPI 1730623265

Doctor of Pharmacy (Pharm.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

14 Historical Events
👤
Provider Name / Credentials Updated August 28, 2024

Recorded as JACK KIM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 28, 2024

Pharmacist (License #PH-4988 in HI)

📍
Updated Practice Location February 14, 2024

Registered at 100 COUNTY ROAD B W, MAPLEWOOD, MN 551171931 (Tel: 6087728773)

📍
Updated Business Mailing Address February 14, 2024

Registered at 100 COUNTY ROAD B W, MAPLEWOOD, MN 551171931 (Tel: 6087728773)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 14, 2024

Pharmacist (License #22263 in WI)

📍
Updated Practice Location September 22, 2023

Registered at 30 FAIRVIEW AVE S, SAINT PAUL, MN 551051463 (Tel: 6087728773)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 22, 2023

Pharmacist (License #PH-4988 in HI)

📍
Updated Practice Location August 21, 2023

Registered at 2199 HWY 36 E, NORTH SAINT PAUL, MN 551096619 (Tel: 6087728773)

NPI Profile Active August 01, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location August 01, 2023

Registered at 1744 SUBURBAN AVE, SAINT PAUL, MN 551066619 (Tel: 6087728773)

📍
Updated Business Mailing Address August 01, 2023

Registered at 1744 SUBURBAN AVE, SAINT PAUL, MN 551066619 (Tel: 6087728773)

👤
Provider Name / Credentials Updated August 01, 2023

Recorded as KYOUNG HEON KIM

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 01, 2023

Pharmacist (License #22263 in WI)

🟢
Initial NPI Registration & Enumeration July 27, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1770264103
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 27, 2023
Last Update: August 28, 2024
Sole Proprietor: No

Mailing Address

100 County Road B W

Maplewood, MN 551171931

Phone: 6087728773

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.