Provider Demographics
NPI:1528594330
Name:MOUA, KA ZOUA
Entity Type:Individual
Prefix:
First Name:KA ZOUA
Middle Name:
Last Name:MOUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 E LASSEN AVE
Mailing Address - Street 2:APARTMENT #1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0568
Mailing Address - Country:US
Mailing Address - Phone:406-830-6864
Mailing Address - Fax:
Practice Address - Street 1:2780 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-1115
Practice Address - Country:US
Practice Address - Phone:406-345-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist