=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821381807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. EDDY TSAO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2011
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10535 HOSPITAL WAY
-----------------------------------------------------
City | MATHER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95655-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-842-7060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11414 GOLD HILL CT
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670-7219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 48622
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------