MEDICARE: THAO N KHAMNOUANE PHARMD

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	48801	TX

General Provider Information

NPI Number	:	1811597040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO N KHAMNOUANE PHARMD

Provider Business Mailing Address
First Line	:	6303 CREEK BLUFF CT
Second Line	:
City	:	SACHSE
State	:	TX
Zip	:	75048-5658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 MCCREE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-3275
Country	:	US
Telephone Number	:	214-461-8777
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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