Provider Demographics
NPI:1568263846
Name:KO KO, KHINE (RPH)
Entity type:Individual
Prefix:
First Name:KHINE
Middle Name:
Last Name:KO KO
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:KHINE
Other - Middle Name:
Other - Last Name:SOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 MARIETTA HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2304
Mailing Address - Country:US
Mailing Address - Phone:770-479-1806
Mailing Address - Fax:
Practice Address - Street 1:129 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2304
Practice Address - Country:US
Practice Address - Phone:770-479-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist