Provider Demographics
NPI:1174070890
Name:KUO, HSIN CHIEH (PHARMD)
Entity type:Individual
Prefix:MR
First Name:HSIN
Middle Name:CHIEH
Last Name:KUO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4205
Mailing Address - Country:US
Mailing Address - Phone:707-961-0464
Mailing Address - Fax:707-961-0460
Practice Address - Street 1:150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4205
Practice Address - Country:US
Practice Address - Phone:707-961-0464
Practice Address - Fax:707-961-0460
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist