Healthcare Provider Details

I. General information

NPI: 1174070890
Provider Name (Legal Business Name): HSIN CHIEH KUO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MAIN ST
FORT BRAGG CA
95437-4205
US

IV. Provider business mailing address

150 S MAIN ST
FORT BRAGG CA
95437-4205
US

V. Phone/Fax

Practice location:
  • Phone: 707-961-0464
  • Fax: 707-961-0460
Mailing address:
  • Phone: 707-961-0464
  • Fax: 707-961-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: