Provider Demographics
NPI:1922469584
Name:CHO, KIHOON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIHOON
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 CHOUTEAU LN
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-2779
Mailing Address - Country:US
Mailing Address - Phone:419-429-9661
Mailing Address - Fax:
Practice Address - Street 1:1003 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1813
Practice Address - Country:US
Practice Address - Phone:573-378-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015012217183500000X
HIPH-3676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist