Healthcare Provider Details

I. General information

NPI: 1174395198
Provider Name (Legal Business Name): KEVIN LAO-CHHAT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 FRANKFORD RD
DALLAS TX
75287-6318
US

IV. Provider business mailing address

3301 CAPSTONE LN
GARLAND TX
75043-2885
US

V. Phone/Fax

Practice location:
  • Phone: 972-662-1011
  • Fax:
Mailing address:
  • Phone: 469-939-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72273
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: