MEDICARE: MR. HYONBO KO RPH

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	37329	TX

General Provider Information

NPI Number	:	1912068248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HYONBO KO RPH

Provider Business Mailing Address
First Line	:	1610 MAIN ST.
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849
Country	:	US
Telephone Number	:	325-446-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 MAIN ST
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3518
Country	:	US
Telephone Number	:	325-446-2511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/21/2022

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