Healthcare Provider Details

I. General information

NPI: 1548917560
Provider Name (Legal Business Name): THAO MOKULEHUA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number62623
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number62623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: