Healthcare Provider Details

I. General information

NPI: 1225270747
Provider Name (Legal Business Name): CHUNGLIANG VICTOR KUO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20670 LONGLEAF PINE AVE
TAMPA FL
33647-3210
US

IV. Provider business mailing address

20670 LONGLEAF PINE AVE
TAMPA FL
33647-3210
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-7284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: