Provider Demographics
NPI:1619418555
Name:VO, KIM (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 UMPQUA ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9587
Mailing Address - Country:US
Mailing Address - Phone:503-916-9861
Mailing Address - Fax:
Practice Address - Street 1:2920 CHAD DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7343
Practice Address - Country:US
Practice Address - Phone:877-887-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2024-01-02
Deactivation Date:2018-11-08
Deactivation Code:
Reactivation Date:2018-11-16
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist