Healthcare Provider Details

I. General information

NPI: 1073306049
Provider Name (Legal Business Name): JESSIE KO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E BROAD ST APT 803
COLUMBUS OH
43203-2024
US

IV. Provider business mailing address

1620 E BROAD ST APT 803
COLUMBUS OH
43203-2024
US

V. Phone/Fax

Practice location:
  • Phone: 614-905-0379
  • Fax:
Mailing address:
  • Phone: 614-905-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: