Provider Demographics
NPI:1952470304
Name:HO, HSIAO TUNG (RPH)
Entity Type:Individual
Prefix:MR
First Name:HSIAO
Middle Name:TUNG
Last Name:HO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:27346 ENGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4926
Mailing Address - Country:US
Mailing Address - Phone:626-806-8585
Mailing Address - Fax:661-267-0813
Practice Address - Street 1:2270 E PALMDALE BLVD
Practice Address - Street 2:UNIT C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4933
Practice Address - Country:US
Practice Address - Phone:661-267-2638
Practice Address - Fax:661-267-0813
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist