Healthcare Provider Details

I. General information

NPI: 1982410940
Provider Name (Legal Business Name): JACQUELINE CAO PHARM D., RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E SPEEDWAY BLVD
TUCSON AZ
85716-3934
US

IV. Provider business mailing address

3200 E SPEEDWAY BLVD
TUCSON AZ
85716-3934
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-6668
  • Fax:
Mailing address:
  • Phone: 480-406-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: