Provider Demographics
NPI:1003898917
Name:LO, KEITH KIMMAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:KIMMAN
Last Name:LO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 NE 4TH ST
Mailing Address - Street 2:H301
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4083
Mailing Address - Country:US
Mailing Address - Phone:425-687-1263
Mailing Address - Fax:
Practice Address - Street 1:12844 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3045
Practice Address - Country:US
Practice Address - Phone:206-248-4625
Practice Address - Fax:206-248-4627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00043322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist