Healthcare Provider Details

I. General information

NPI: 1760122444
Provider Name (Legal Business Name): QUYNH NHU DAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QUYNH DAO PHARMD

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 TENNESSEE AVE N
PARSONS TN
38363-5049
US

IV. Provider business mailing address

1971 TENNESSEE AVE N
PARSONS TN
38363-5049
US

V. Phone/Fax

Practice location:
  • Phone: 504-427-3853
  • Fax:
Mailing address:
  • Phone: 731-847-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number43822
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: