Healthcare Provider Details

I. General information

NPI: 1174619340
Provider Name (Legal Business Name): THUAVU DUC CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

IV. Provider business mailing address

6600 TRONZANO WAY
ELK GROVE CA
95757-3057
US

V. Phone/Fax

Practice location:
  • Phone: 916-688-2529
  • Fax: 916-688-2973
Mailing address:
  • Phone: 916-714-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: