MEDICARE: DR. GERALD KO PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	53893	CA

General Provider Information

NPI Number	:	1134120736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD KO PHARM.D.

Provider Business Mailing Address
First Line	:	4280 VIA ARBOLADA UNIT 223
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-5088
Country	:	US
Telephone Number	:	323-707-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 STATE UNIVERSITY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-4226
Country	:	US
Telephone Number	:	323-343-3317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	06/16/2020

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