Healthcare Provider Details

I. General information

NPI: 1114694957
Provider Name (Legal Business Name): ALEXANDER THAI CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEX THAI CAO PHARMD

II. Dates (important events)

Enumeration Date: 08/29/2021
Last Update Date: 08/29/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 SW 22ND PL
TOPEKA KS
66614-1500
US

IV. Provider business mailing address

2216 ALABAMA ST
LAWRENCE KS
66046-2857
US

V. Phone/Fax

Practice location:
  • Phone: 785-228-8762
  • Fax:
Mailing address:
  • Phone: 316-734-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-103743
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: