Healthcare Provider Details

I. General information

NPI: 1952742355
Provider Name (Legal Business Name): MY DUY CAO PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 07/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 SE 82ND AVE
PORTLAND OR
97086-3603
US

IV. Provider business mailing address

6416 SE DUNBAR DR
PORTLAND OR
97236-5070
US

V. Phone/Fax

Practice location:
  • Phone: 503-788-2033
  • Fax:
Mailing address:
  • Phone: 503-816-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011381
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: