Healthcare Provider Details

I. General information

NPI: 1386972560
Provider Name (Legal Business Name): PHONG DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 JONES RD
HOUSTON TX
77070-4802
US

IV. Provider business mailing address

12300 JONES RD
HOUSTON TX
77070-4802
US

V. Phone/Fax

Practice location:
  • Phone: 281-955-5619
  • Fax:
Mailing address:
  • Phone: 281-955-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41677
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: