Provider Demographics
NPI:1518941319
Name:THIEU-TRANG T CAO
Entity Type:Organization
Organization Name:THIEU-TRANG T CAO
Other - Org Name:ANA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THIEU TRANG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-350-1719
Mailing Address - Street 1:3513 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3211
Mailing Address - Country:US
Mailing Address - Phone:626-350-1719
Mailing Address - Fax:626-350-4338
Practice Address - Street 1:3513 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3211
Practice Address - Country:US
Practice Address - Phone:626-350-1719
Practice Address - Fax:626-350-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43963333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0575095OtherNABP
CAPHA439630Medicaid
CAPHA439630Medicaid