Provider Demographics
NPI:1669854253
Name:KHA, DAO B (RPH)
Entity Type:Individual
Prefix:
First Name:DAO
Middle Name:B
Last Name:KHA
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 1:6280 HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3492
Mailing Address - Country:US
Mailing Address - Phone:318-965-3669
Mailing Address - Fax:318-965-3670
Practice Address - Street 1:6280 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-3492
Practice Address - Country:US
Practice Address - Phone:318-965-3669
Practice Address - Fax:318-965-3670
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist