Healthcare Provider Details

I. General information

NPI: 1720895956
Provider Name (Legal Business Name): JOHN CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TECHNOLOGY CENTER DR
STOUGHTON MA
02072-4710
US

IV. Provider business mailing address

39 RUTGERS ST APT 2
ROCHESTER NY
14607-2857
US

V. Phone/Fax

Practice location:
  • Phone: 781-566-5066
  • Fax:
Mailing address:
  • Phone: 917-348-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: