Healthcare Provider Details

I. General information

NPI: 1457636748
Provider Name (Legal Business Name): PEI HWA KUO R. PH PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 KELLEY STREET
HOUSTON TX
77026
US

IV. Provider business mailing address

5656 KELLEY STREET
HOUSTON TX
77026
US

V. Phone/Fax

Practice location:
  • Phone: 713-566-5136
  • Fax:
Mailing address:
  • Phone: 713-566-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number41979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: