MEDICARE: PETER HOANG ANH CAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0023222	CO

General Provider Information

NPI Number	:	1306458856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER HOANG ANH CAO

Provider Business Mailing Address
First Line	:	1520 MAIN ST
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-7909
Country	:	US
Telephone Number	:	970-674-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 MAIN ST
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-7909
Country	:	US
Telephone Number	:	970-674-2840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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Directions to “ PETER HOANG ANH CAO ” Practice Location

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