Provider Demographics
NPI:1487248233
Name:THAO, GAOZOUA NALEE (CPHT)
Entity type:Individual
Prefix:
First Name:GAOZOUA
Middle Name:NALEE
Last Name:THAO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:GAOZOUA
Other - Middle Name:NALEE
Other - Last Name:THAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NALEE
Mailing Address - Street 1:1178 W 410 RD
Mailing Address - Street 2:
Mailing Address - City:ADAIR
Mailing Address - State:OK
Mailing Address - Zip Code:74330-3267
Mailing Address - Country:US
Mailing Address - Phone:651-788-5129
Mailing Address - Fax:
Practice Address - Street 1:1500 S LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8399
Practice Address - Country:US
Practice Address - Phone:918-341-5181
Practice Address - Fax:918-341-4888
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT7885183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK742769OtherNABP