Provider Demographics
NPI:1134274970
Name:OH, TAEHO (RPH)
Entity type:Individual
Prefix:
First Name:TAEHO
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12685 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2417
Mailing Address - Country:US
Mailing Address - Phone:305-892-8994
Mailing Address - Fax:
Practice Address - Street 1:12685 MAPLE RD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2417
Practice Address - Country:US
Practice Address - Phone:305-892-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS227051835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22705OtherPHARMACIST