Provider Demographics
NPI:1629439955
Name:CHO, ANSUK
Entity Type:Individual
Prefix:
First Name:ANSUK
Middle Name:
Last Name:CHO
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 1:4415 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-6351
Mailing Address - Country:US
Mailing Address - Phone:903-831-5882
Mailing Address - Fax:903-831-6421
Practice Address - Street 1:4415 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-6351
Practice Address - Country:US
Practice Address - Phone:903-831-5882
Practice Address - Fax:903-831-6421
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist