Healthcare Provider Details

I. General information

NPI: 1922876366
Provider Name (Legal Business Name): NICHOLAS CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S ATLANTIC BLVD
MONTEREY PARK CA
91754-6801
US

IV. Provider business mailing address

2970 WALLINGFORD RD
SAN MARINO CA
91108-1552
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-3524
  • Fax:
Mailing address:
  • Phone: 626-316-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: