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General NPI Number Information
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NPI Number | 1447738141
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Entity Type | Individual
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Provider Name | TRIEU BAO
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Gender | Male
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 801 LANDMARK DR STE B
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4986
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Country | US
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Telephone | 443-281-9157
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Fax | 410-582-8728
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Provider Business Mailing Address
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Address Line | 801 LANDMARK DR STE B
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4986
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Country | US
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Telephone | 443-281-9157
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Fax | 410-582-8728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16045
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License Number State | MD
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