Healthcare Provider Details

I. General information

NPI: 1720647415
Provider Name (Legal Business Name): KAREN MAI CAO PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 FAIR OAKS BLVD
SACRAMENTO CA
95825-7685
US

IV. Provider business mailing address

2501 FAIR OAKS BLVD
SACRAMENTO CA
95825-7685
US

V. Phone/Fax

Practice location:
  • Phone: 916-484-7016
  • Fax: 916-484-7023
Mailing address:
  • Phone: 916-484-7016
  • Fax: 916-484-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: