Provider Demographics
NPI:1124622287
Name:CAO, CAROLIN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CAROLIN
Middle Name:
Last Name:CAO
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 1:50 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1750
Mailing Address - Country:US
Mailing Address - Phone:617-899-7547
Mailing Address - Fax:
Practice Address - Street 1:587 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3601
Practice Address - Country:US
Practice Address - Phone:617-437-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist