Provider Demographics
NPI:1518099134
Name:TSAO, EDWARD DOUGLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DOUGLAS
Last Name:TSAO
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 1:4315 MARTENS RD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-9047
Mailing Address - Country:US
Mailing Address - Phone:715-479-1718
Mailing Address - Fax:
Practice Address - Street 1:4315 MARTENS ROAD
Practice Address - Street 2:UNIT 1
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-9047
Practice Address - Country:US
Practice Address - Phone:715-479-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17534183500000X
NV15217183500000X
MO042556183500000X
IL051-038303183500000X
WI12792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist