Provider Demographics
NPI:1518267848
Name:KO, JAMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KO
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 1:2684 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2438
Mailing Address - Country:US
Mailing Address - Phone:714-637-2140
Mailing Address - Fax:714-637-2577
Practice Address - Street 1:2684 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-2438
Practice Address - Country:US
Practice Address - Phone:714-637-2140
Practice Address - Fax:714-637-2577
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist