| Doctor Name: | MR. KIM G CONNER |
| NPI Number: | 1558673707 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.PH. M.AC |
| License Number: | 12008 |
| Business Practice Address: | 4834 Water Park Dr Belcamp, MD - 210171442 |
| Business Phone Number: | 4438389698 |
| Business Fax Number: | |
| Mailing Address: | 4801 Yellowwood Ave, BALTIMORE |
| State: | MD |
| Postal Code: | 212094622 |
| Phone Number: | 4105922752 |
| Fax Number: | 4433276547 |
| NPI Enumeration Date: | 07/04/2010 |
| NPI Last Update Date: | 07/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | 12008 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |