Healthcare Provider Details

I. General information

NPI: 1093049637
Provider Name (Legal Business Name): ROSE ANN KAO R PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 PARADISE BLVD NW
ALBUQUERQUE NM
87114-1467
US

IV. Provider business mailing address

203 OLGUIN RD
CORRALES NM
87048-6932
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-0983
  • Fax:
Mailing address:
  • Phone: 505-897-4905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4946
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: