Provider Demographics
NPI:1033425624
Name:KO, NANCY M (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:KO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20107 E COVINA HILLS RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3629
Mailing Address - Country:US
Mailing Address - Phone:626-859-0580
Mailing Address - Fax:
Practice Address - Street 1:8580 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2520
Practice Address - Country:US
Practice Address - Phone:562-942-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist