Provider Demographics
NPI:1215274121
Name:LO, KANG-SHA
Entity type:Individual
Prefix:
First Name:KANG-SHA
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5434
Mailing Address - Country:US
Mailing Address - Phone:770-682-2627
Mailing Address - Fax:770-682-2632
Practice Address - Street 1:831 AUBURN RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5434
Practice Address - Country:US
Practice Address - Phone:770-682-2627
Practice Address - Fax:770-682-2632
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist