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General NPI Number Information
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NPI Number | 1518941319
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Entity Type | Organization
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Legal Business Name | THIEU-TRANG T CAO
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 3513 JOHNSON AVE
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City | EL MONTE
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State | CA
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Zip | 91731-3211
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Country | US
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Telephone | 626-350-1719
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Fax | 626-350-4338
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Provider Business Mailing Address
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Address Line | 3513 JOHNSON AVE
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City | EL MONTE
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State | CA
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Zip | 91731-3211
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Country | US
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Telephone | 626-350-1719
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Fax | 626-350-4338
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE OWNER
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Name | MRS. THIEU TRANG THI CAO
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Credential | RPH
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Telephone | 626-350-1719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY43963
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License Number State | CA
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