Provider Demographics
NPI:1326414467
Name:KO, ENOCH CHIA HAN
Entity Type:Individual
Prefix:
First Name:ENOCH
Middle Name:CHIA HAN
Last Name:KO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12010 COUNTY LINE RD
Practice Address - Street 2:APT 1208
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35756-2000
Practice Address - Country:US
Practice Address - Phone:256-230-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist