Provider Demographics
NPI:1679644843
Name:LA, ANH-DAO T (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:ANH-DAO
Middle Name:T
Last Name:LA
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:DR
Other - First Name:ANH
Other - Middle Name:T
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, BCPS
Mailing Address - Street 1:3822 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3822 EAST AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4036
Practice Address - Country:US
Practice Address - Phone:708-749-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy