Healthcare Provider Details

I. General information

NPI: 1689167488
Provider Name (Legal Business Name): CHAU THOAI ONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 HICKORY CREEK BLVD
HICKORY CREEK TX
75065-7552
US

IV. Provider business mailing address

1401 BARRIER ISLAND DR
AUBREY TX
76227-1279
US

V. Phone/Fax

Practice location:
  • Phone: 940-321-5686
  • Fax:
Mailing address:
  • Phone: 843-327-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57558
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: