MEDICARE: TONY VO

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	RP452524	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP452524	OTHER		PHARMACIST STATE LICENSE

General Provider Information

NPI Number	:	1841894094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY VO

Provider Business Mailing Address
First Line	:	5843 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5843 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1144
Country	:	US
Telephone Number	:	215-728-4146
Fax Number	:

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

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ TONY VO ” Practice Location

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