Healthcare Provider Details

I. General information

NPI: 1154919777
Provider Name (Legal Business Name): LOC DAO R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S MORTON AVE
MORTON PA
19070-1799
US

IV. Provider business mailing address

35 S MORTON AVE
MORTON PA
19070-1799
US

V. Phone/Fax

Practice location:
  • Phone: 610-543-1858
  • Fax:
Mailing address:
  • Phone: 610-543-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP043503L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: