Healthcare Provider Details

I. General information

NPI: 1346771144
Provider Name (Legal Business Name): IRENE KUO PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MUIR ROAD
MARTINEZ CA
94553
US

IV. Provider business mailing address

400 MUIR ROAD
MARTINEZ CA
94553
US

V. Phone/Fax

Practice location:
  • Phone: 925-313-4544
  • Fax: 925-372-1714
Mailing address:
  • Phone: 925-313-4544
  • Fax: 925-372-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: