Healthcare Provider Details

I. General information

NPI: 1376165837
Provider Name (Legal Business Name): THAI CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6902
US

IV. Provider business mailing address

201 AUSTIN VILLAGE BLVD
LAFAYETTE LA
70508-6452
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5500
  • Fax:
Mailing address:
  • Phone: 337-654-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number015616
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: