Healthcare Provider Details

I. General information

NPI: 1184209082
Provider Name (Legal Business Name): LINCOLN CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 LJ PKWY
SUGAR LAND TX
77479-3723
US

IV. Provider business mailing address

6406 WINDERMERE PARK LN
SUGAR LAND TX
77479-3622
US

V. Phone/Fax

Practice location:
  • Phone: 281-265-0562
  • Fax:
Mailing address:
  • Phone: 281-382-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66937
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: