Provider Demographics
NPI:1134120736
Name:KO, GERALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:KO
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 1:4280 VIA ARBOLADA UNIT 223
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5088
Mailing Address - Country:US
Mailing Address - Phone:323-707-3488
Mailing Address - Fax:
Practice Address - Street 1:5151 STATE UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-4226
Practice Address - Country:US
Practice Address - Phone:323-343-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist