Healthcare Provider Details

I. General information

NPI: 1568691103
Provider Name (Legal Business Name): JOHN D CAO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E RIGGS RD
CHANDLER AZ
85249-3670
US

IV. Provider business mailing address

1703 E JADE PL
CHANDLER AZ
85286-2292
US

V. Phone/Fax

Practice location:
  • Phone: 480-802-3852
  • Fax:
Mailing address:
  • Phone: 480-250-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012702
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: