Provider Demographics
NPI:1235407255
Name:KO, CHRISTINE Y (PHARM, D)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:Y
Last Name:KO
Suffix:
Gender:M
Credentials:PHARM, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SILVERBERRY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4176
Mailing Address - Country:US
Mailing Address - Phone:714-530-1071
Mailing Address - Fax:714-530-2637
Practice Address - Street 1:12001 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3332
Practice Address - Country:US
Practice Address - Phone:714-530-1071
Practice Address - Fax:714-530-2637
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist