Provider Demographics
NPI:1710756200
Name:CAO, BRYAN K
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:CAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 VERONA ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2336
Mailing Address - Country:US
Mailing Address - Phone:781-479-7468
Mailing Address - Fax:
Practice Address - Street 1:2 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7911
Practice Address - Country:US
Practice Address - Phone:978-532-1600
Practice Address - Fax:978-532-1600
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT8054183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician