Healthcare Provider Details

I. General information

NPI: 1609256817
Provider Name (Legal Business Name): HO KIM THU PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5523 E GRANT RD
TUCSON AZ
85712-2209
US

IV. Provider business mailing address

5523 E GRANT RD
TUCSON AZ
85712-2209
US

V. Phone/Fax

Practice location:
  • Phone: 520-298-9038
  • Fax: 520-298-9907
Mailing address:
  • Phone: 520-298-9038
  • Fax: 520-298-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006461
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THU HO
Title or Position: OWNER, PIC, AO
Credential: PHARMD
Phone: 520-298-9038