Healthcare Provider Details

I. General information

NPI: 1801377619
Provider Name (Legal Business Name): CHRISTINA LEE KUO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7548 SOQUEL DR
APTOS CA
95003-3820
US

IV. Provider business mailing address

7548 SOQUEL DR
APTOS CA
95003-3820
US

V. Phone/Fax

Practice location:
  • Phone: 831-685-1100
  • Fax: 831-685-1132
Mailing address:
  • Phone: 831-685-1100
  • Fax: 831-685-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: