Healthcare Provider Details

I. General information

NPI: 1619205457
Provider Name (Legal Business Name): MYA DALENA DAO PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 AIRPORT BLVD
AUSTIN TX
78702-3163
US

IV. Provider business mailing address

1501 TUDOR HOUSE RD
PFLUGERVILLE TX
78660-7907
US

V. Phone/Fax

Practice location:
  • Phone: 512-929-0961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: