Provider Demographics
NPI:1194037903
Name:KO, YOUNG NAM (RPH)
Entity Type:Individual
Prefix:
First Name:YOUNG NAM
Middle Name:
Last Name:KO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARSONAGE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2424
Mailing Address - Country:US
Mailing Address - Phone:732-744-0702
Mailing Address - Fax:732-744-0702
Practice Address - Street 1:100 PARSONAGE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2424
Practice Address - Country:US
Practice Address - Phone:732-744-0702
Practice Address - Fax:732-744-0702
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02088600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist