Provider Demographics
NPI:1083076095
Name:CHO, ELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12746 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 3160
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2885
Mailing Address - Country:US
Mailing Address - Phone:310-862-9810
Mailing Address - Fax:310-862-9811
Practice Address - Street 1:12746 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 3160
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90094-2885
Practice Address - Country:US
Practice Address - Phone:310-862-9810
Practice Address - Fax:310-862-9811
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist