Healthcare Provider Details

I. General information

NPI: 1083251003
Provider Name (Legal Business Name): THANH DAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 COLEMAN AVE
SAN JOSE CA
95110-2047
US

IV. Provider business mailing address

1348 FLICKINGER AVE
SAN JOSE CA
95131-2814
US

V. Phone/Fax

Practice location:
  • Phone: 408-346-2023
  • Fax:
Mailing address:
  • Phone: 408-666-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH81572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: