Healthcare Provider Details

I. General information

NPI: 1306457692
Provider Name (Legal Business Name): DR. TRI CHAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 WILMINGTON AVE
DAYTON OH
45420-1662
US

IV. Provider business mailing address

632 W STROOP RD
KETTERING OH
45429-1658
US

V. Phone/Fax

Practice location:
  • Phone: 937-252-9894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03322156
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: