Provider Demographics
NPI:1093049637
Name:KAO, ROSE ANN (R PH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANN
Last Name:KAO
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OLGUIN RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-6932
Mailing Address - Country:US
Mailing Address - Phone:505-897-4905
Mailing Address - Fax:
Practice Address - Street 1:6565 PARADISE BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1467
Practice Address - Country:US
Practice Address - Phone:505-217-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000000004946Medicaid