Provider Demographics
NPI:1174692057
Name:KO, AEDUK NM (RPH)
Entity type:Individual
Prefix:MS
First Name:AEDUK
Middle Name:NM
Last Name:KO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KAPIOLANI BLVD APT 1806
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-6004
Mailing Address - Country:US
Mailing Address - Phone:808-593-1166
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:PHARMACY SERVICE
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-6337
Practice Address - Fax:808-433-6371
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist