Healthcare Provider Details

I. General information

NPI: 1548189053
Provider Name (Legal Business Name): KEVIN QUANG CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W 6TH ST
LAWRENCE KS
66049-4534
US

IV. Provider business mailing address

3000 W 6TH ST
LAWRENCE KS
66049-4534
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-0847
  • Fax:
Mailing address:
  • Phone: 785-843-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2023030970
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number1-105466
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: