MEDICARE: KONDO ENTERPRISES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PD08105	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0418649	OTHER	AR	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184765315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONDO ENTERPRISES CORP

Provider Business Mailing Address
First Line	:	11321 INTERSTATE 30
Second Line	:	SUITE 102
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7040
Country	:	US
Telephone Number	:	501-353-2136
Fax Number	:	501-353-2594

Provider Business Practice Location Address
First Line	:	11321 INTERSTATE 30
Second Line	:	SUITE 102
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7040
Country	:	US
Telephone Number	:	501-353-2136
Fax Number	:	501-353-2594

Authorized Official
Title or Position	:	PHARMACIST, PRESIDENT, CEO
Name	:	DR. YAO KONDO
Credential	:	P.D.
Telephone Number	:	501-353-2136

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/27/2012

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Directions to “KONDO ENTERPRISES CORP ” Practice Location

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