Provider Demographics
NPI:1376112722
Name:CHAO, MICHAEL SHANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANG
Last Name:CHAO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7268 DUBOSE CRK
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6047
Mailing Address - Country:US
Mailing Address - Phone:903-504-2300
Mailing Address - Fax:
Practice Address - Street 1:7268 DUBOSE CRK
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6047
Practice Address - Country:US
Practice Address - Phone:903-504-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist