Provider Demographics
NPI:1114296399
Name:CAO, BINH M
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:M
Last Name:CAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 NAPFLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2742
Mailing Address - Country:US
Mailing Address - Phone:610-306-4240
Mailing Address - Fax:
Practice Address - Street 1:1528 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4311
Practice Address - Country:US
Practice Address - Phone:215-765-9332
Practice Address - Fax:215-769-5496
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2937YY27183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist