Provider Demographics
NPI:1942595509
Name:SEO, JAE HO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HO
Last Name:SEO
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 1:6845 SIERRA CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2214
Mailing Address - Country:US
Mailing Address - Phone:775-853-8916
Mailing Address - Fax:775-853-8916
Practice Address - Street 1:6845 SIERRA CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2214
Practice Address - Country:US
Practice Address - Phone:775-853-8916
Practice Address - Fax:775-853-8916
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist