Provider Demographics
NPI:1861602724
Name:KOO, PAUL C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:KOO
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 1:13591 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1364
Mailing Address - Country:US
Mailing Address - Phone:909-628-2999
Mailing Address - Fax:
Practice Address - Street 1:725 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2614
Practice Address - Country:US
Practice Address - Phone:626-338-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist