Healthcare Provider Details

I. General information

NPI: 1962756064
Provider Name (Legal Business Name): CHRISTOPHER THAI CAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

2449 MAXSON RD
EL MONTE CA
91732-3716
US

V. Phone/Fax

Practice location:
  • Phone: 626-246-8599
  • Fax:
Mailing address:
  • Phone: 626-246-8599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12620
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: