Provider Demographics
NPI:1093086449
Name:KAO, EMILY AGATHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:AGATHA
Last Name:KAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 STATION VILLAGE WAY
Mailing Address - Street 2:APT 2438
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6521
Mailing Address - Country:US
Mailing Address - Phone:217-493-2695
Mailing Address - Fax:
Practice Address - Street 1:215 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7243
Practice Address - Country:US
Practice Address - Phone:619-401-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292814183500000X
CA66549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist