Healthcare Provider Details

I. General information

NPI: 1164394755
Provider Name (Legal Business Name): KEVIN MINH-HIEU CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PASS RD
BILOXI MS
39531-2111
US

IV. Provider business mailing address

8495 LOUISE ST
BILOXI MS
39532-8275
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-3458
  • Fax: 228-388-4091
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102141
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: