Provider Demographics
NPI:1528593050
Name:MAO, TONY (RPH)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:MAO
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 1:13341 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2051
Mailing Address - Country:US
Mailing Address - Phone:626-641-6416
Mailing Address - Fax:
Practice Address - Street 1:13341 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2051
Practice Address - Country:US
Practice Address - Phone:626-641-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist