Provider Demographics
NPI:1992009625
Name:LO, MIMI MING (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:MING
Last Name:LO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10341 ALPINE DR APT B
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0924
Mailing Address - Country:US
Mailing Address - Phone:765-414-2099
Mailing Address - Fax:
Practice Address - Street 1:10341 ALPINE DR APT B
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0924
Practice Address - Country:US
Practice Address - Phone:765-414-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000568791835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology