Provider Demographics
NPI:1932512662
Name:CAO, IRENE
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 W EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1946
Mailing Address - Country:US
Mailing Address - Phone:916-920-3558
Mailing Address - Fax:916-920-7840
Practice Address - Street 1:1540 W EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-1946
Practice Address - Country:US
Practice Address - Phone:916-920-3558
Practice Address - Fax:916-920-7840
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist