Provider Demographics
NPI:1952609265
Name:KHO, SOEDARJANTO (RPH)
Entity Type:Individual
Prefix:
First Name:SOEDARJANTO
Middle Name:
Last Name:KHO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:KHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:7004 TALTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9003
Mailing Address - Country:US
Mailing Address - Phone:919-380-7578
Mailing Address - Fax:
Practice Address - Street 1:1909 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2926
Practice Address - Country:US
Practice Address - Phone:336-227-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist