Provider Demographics
NPI:1366887416
Name:OU, KATHY (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:OU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3500
Mailing Address - Country:US
Mailing Address - Phone:909-594-8331
Mailing Address - Fax:
Practice Address - Street 1:2707 S DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3500
Practice Address - Country:US
Practice Address - Phone:909-594-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist