Provider Demographics
NPI:1649878489
Name:THAOXAOCHAY, ALISIA NTXUACOUA (RPH)
Entity type:Individual
Prefix:
First Name:ALISIA
Middle Name:NTXUACOUA
Last Name:THAOXAOCHAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 S ELM AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5732
Mailing Address - Country:US
Mailing Address - Phone:559-240-3151
Mailing Address - Fax:
Practice Address - Street 1:2539 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-1426
Practice Address - Country:US
Practice Address - Phone:559-585-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist