Provider Demographics
NPI:1033421714
Name:UKOH, UKO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:UKO
Middle Name:
Last Name:UKOH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0861
Mailing Address - Country:US
Mailing Address - Phone:781-964-3363
Mailing Address - Fax:
Practice Address - Street 1:80 MAYFLOWER CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0861
Practice Address - Country:US
Practice Address - Phone:781-964-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist