Healthcare Provider Details

I. General information

NPI: 1992461115
Provider Name (Legal Business Name): THONG DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 TATES CREEK RD
LEXINGTON KY
40502-3467
US

IV. Provider business mailing address

3349 TATES CREEK RD
LEXINGTON KY
40502-3467
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022389
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: