=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932784196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TUAN MINH PETER CAO PHARMD, RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2021
-----------------------------------------------------
Last Update Date | 03/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 LOCUST ST
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-2052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-582-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 MONTCALM ST APT 107M
-----------------------------------------------------
City | CHICOPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01020-4058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-416-8518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH239843
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------