Provider Demographics
NPI:1619694437
Name:LA, THAO (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:
Last Name:LA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 BROADLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3384
Mailing Address - Country:US
Mailing Address - Phone:951-445-9780
Mailing Address - Fax:
Practice Address - Street 1:3228 BROADLEAF WAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3384
Practice Address - Country:US
Practice Address - Phone:951-445-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist