Healthcare Provider Details

I. General information

NPI: 1629672084
Provider Name (Legal Business Name): JEFFREY NGUYEN CAO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11885 GRAND COMMONS AVE APT 308
FAIRFAX VA
22030-8626
US

IV. Provider business mailing address

11885 GRAND COMMONS AVE APT 308
FAIRFAX VA
22030-8626
US

V. Phone/Fax

Practice location:
  • Phone: 412-951-5106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1920855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: