Provider Demographics
NPI:1568691103
Name:CAO, JOHN D (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:CAO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 E JADE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2292
Mailing Address - Country:US
Mailing Address - Phone:480-250-0994
Mailing Address - Fax:
Practice Address - Street 1:1055 E RIGGS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3670
Practice Address - Country:US
Practice Address - Phone:480-802-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ012702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist