Healthcare Provider Details

I. General information

NPI: 1285008425
Provider Name (Legal Business Name): PHYLLIS H KUO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12358 POWAY RD
POWAY CA
92064-4219
US

IV. Provider business mailing address

12428 VIA CABEZON
SAN DIEGO CA
92129-3903
US

V. Phone/Fax

Practice location:
  • Phone: 858-748-9220
  • Fax: 858-748-5180
Mailing address:
  • Phone: 858-780-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: