Provider Demographics
NPI:1518482777
Name:LO, MICHELLE YUEN KIU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:YUEN KIU
Last Name:LO
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 1:712 HENDRIX AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4520
Mailing Address - Country:US
Mailing Address - Phone:650-520-0947
Mailing Address - Fax:
Practice Address - Street 1:11845 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-8602
Practice Address - Country:US
Practice Address - Phone:301-468-3238
Practice Address - Fax:301-468-3415
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE