Provider Demographics
NPI:1578164737
Name:KIOKO, MAJELLA M
Entity Type:Individual
Prefix:
First Name:MAJELLA
Middle Name:M
Last Name:KIOKO
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 1:2843 MACQUARIE ST
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-1585
Mailing Address - Country:US
Mailing Address - Phone:913-231-2773
Mailing Address - Fax:
Practice Address - Street 1:6756 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9156
Practice Address - Country:US
Practice Address - Phone:817-732-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist