Healthcare Provider Details

I. General information

NPI: 1205448768
Provider Name (Legal Business Name): THAO DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S INTERNATIONAL PKWY
LAKE MARY FL
32746-1615
US

IV. Provider business mailing address

1201 S INTERNATIONAL PKWY
LAKE MARY FL
32746-1615
US

V. Phone/Fax

Practice location:
  • Phone: 407-805-9148
  • Fax: 407-805-0126
Mailing address:
  • Phone: 407-805-9148
  • Fax: 407-805-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: