Provider Demographics
NPI:1720306962
Name:LO, CHONG HOUA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:HOUA
Last Name:LO
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 1:8951 VALLEY FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-578-3730
Mailing Address - Fax:864-599-9336
Practice Address - Street 1:8951 VALLEY FALLS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5349
Practice Address - Country:US
Practice Address - Phone:864-578-3730
Practice Address - Fax:864-599-9336
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist