Individual
CHINAGOROM ILO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1305 W BELT LINE RD, DESOTO, TX 75115-3627
(972) 223-0222
Mailing address
1305 W BELT LINE RD, DESOTO, TX 75115-3627
(972) 223-0222
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
65650
TX
Other
Enumeration date
11/27/2020
Last updated
11/27/2020
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