Healthcare Provider Details

I. General information

NPI: 1730802489
Provider Name (Legal Business Name): ANNA CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 S LOOP 256
PALESTINE TX
75801-5919
US

IV. Provider business mailing address

2107 SOUTH LOOP 256 PHARMACY
PALESTINE TX
75801
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-1092
  • Fax: 903-729-2652
Mailing address:
  • Phone: 903-723-1092
  • Fax: 903-729-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: