Healthcare Provider Details

I. General information

NPI: 1114296399
Provider Name (Legal Business Name): BINH M CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2011
Last Update Date: 12/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 N BROAD ST
PHILADELPHIA PA
19121-4311
US

IV. Provider business mailing address

1131 NAPFLE AVE
PHILADELPHIA PA
19111-2742
US

V. Phone/Fax

Practice location:
  • Phone: 215-765-9332
  • Fax: 215-769-5496
Mailing address:
  • Phone: 610-306-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2937YY27
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: