Healthcare Provider Details

I. General information

NPI: 1760831242
Provider Name (Legal Business Name): JOHN THANH CAO PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 W GAIL DR
CHANDLER AZ
85226-1226
US

IV. Provider business mailing address

5590 W GAIL DR
CHANDLER AZ
85226-1226
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-9825
  • Fax:
Mailing address:
  • Phone: 480-321-9825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022162
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: