Provider Demographics
NPI:1134696479
Name:THAO, XIONG PAO (RPH)
Entity Type:Individual
Prefix:
First Name:XIONG PAO
Middle Name:
Last Name:THAO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S IRISH RD
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1773
Mailing Address - Country:US
Mailing Address - Phone:920-849-7330
Mailing Address - Fax:
Practice Address - Street 1:810 S IRISH RD
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1773
Practice Address - Country:US
Practice Address - Phone:920-849-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19400-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist