Provider Demographics
NPI:1669770921
Name:THAO, GER SUNNIE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GER
Middle Name:SUNNIE
Last Name:THAO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W ASHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-5611
Mailing Address - Country:US
Mailing Address - Phone:559-291-1084
Mailing Address - Fax:559-348-2273
Practice Address - Street 1:380 W ASHLAN AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5611
Practice Address - Country:US
Practice Address - Phone:559-291-1084
Practice Address - Fax:559-348-2273
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 534241835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist